Patient interviewing Trauma/Medical

ZachJCH

ZachJCH

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I'm currently taking EMS Operations class which is super fun however finding the right questions to ask your trauma/medical patient can be difficult sometimes. Are there specific questions that people use out in the field while interviewing their patients that they don't teach in school? (Trauma Tango and all that jazz). I remember when I did my ride along, one of the preceptors had a list of 5 questions that he would always ask his patients while interviewing them. I'm wanting to make my own list of questions to always ask my trauma/medical patients in case my brain goes blank, or at least give myself something to go off of. Thanks!
 
PM me your email, I have a list I can send you that has specific questions based on complaint. I don't always use everything from said list, but its good to have in your back pocket.

In my experience, the patient complaint is generally pretty obvious, you/I just need to figure out if it is what they say it is. ie cardiac chest pain vs pleuritic/muscular

I might be able to PM it to you, but im not sure how to attach links
 
Hope the patient gives you the answers in any memorized algorithm too. If not it derails quickly.

Such as:
EMT: "How is your breathing?"
Pt: "Tangerine".:unsure:

You want to intro self (consent and establish mental alertness, hearing); ask about allergies then meds so you don't kill them with your treatments if they fall unconscious before your eval is over (bored 'em to death:rofl:); ask what happened and/or primary complaint as you begin palpation and auscultation.

You need to be using all your senses on approach and after contact to gather data. Select the trauma assessment that will get you through the class then ;learn more on the job. This forum is good for getting suggestions as to what to ask.
 
Other than sticking to open-ended questions, I wouldn't fixate too much on a standard list. Start by thinking in terms of what you'd want to know as a casual observer -- What happened? What hurts? Build on that -- e.g. "Besides that bump on your head, what else hurts?" Let a patient's answers to one question help you form the next. You'll start working in some of that ample/sample/tango stuff because you want to know it, not because somebody said you have to.
 
My questions are geared toward what is going one. Besides the usual assessment questions it really depends on the pt. I don't have or use a set script or each pt. once you get some experience and get comfortable you will find your own rhythm .
 
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A few goodies that aren't always emphasized in class but bear great dividends:

-- How does your chest feel? (exactly those words)
-- Have you ever felt this way before? (or if there's something salient in their history, you can specifically ask if it feels like that -- better, worse? etc)
-- How have you been feeling recently? (that is, before the current event)
-- When's the last time you were in the hospital? (good follow-up to the previous; many people will say "fine" but it turns out they were hospitalized last week)
-- Who called us? Why did you call us? (when the patient either denies any complaint or has ten thousand complaints and you can't figure out what actually prompted concern today)
-- Any changes in your diet or medications recently? Been feeling any fever or chills? Still going to the bathroom? Any changes there? (good general high-yields)
-- What do you mean when you say "dizzy"? Like you're lightheaded or like the room is spinning? (for "dizzy" calls)
-- Anything else bothering you? (nice catch-all wrap-up once you've sorted out the main complaint)
 
You will quickly figure out that most of what a pt. tells you turns out to be useless. They don't know their medications, their previous diagnosis, what their past hospitalizations are for.

My 2 cents is to start the physical exam as quickly as possible and be on the look out for signs of previous medical procedures (IV sticks, scars on the chest). Ask whatever questions you want to ask while examining the pt.

And remember, if someone says that they have had X amount of alcohol, they probably have had twice that.
 
MonkeyArrow said:
You will quickly figure out that most of what a pt. tells you turns out to be useless. They don't know their medications, their previous diagnosis, what their past hospitalizations are for.

My 2 cents is to start the physical exam as quickly as possible and be on the look out for signs of previous medical procedures (IV sticks, scars on the chest). Ask whatever questions you want to ask while examining the pt.

And remember, if someone says that they have had X amount of alcohol, they probably have had twice that.
Click to expand...

I'm going to have to disagree with most of this. If you are getting primarily useless information, you are likely asking the wrong questions. No, not every patient is the greatest historian, but that doesn't mean what they have to tell you is of little value.

Brandon hit on many great questions. My response will be more vague, rather than geared to specific questions.

As was mentioned, one of the first things you need to do is figure out what they called for- their chief complaint. Their response should immediately put a slew of differential diagnoses in your head, or a list of things you think could possibly be wrong.

Once you have your list of differentials, your questions should be geared to help you sift through them, ideally starting with the most likely. You'll likely have to use a combination of open and closed-ended questions; open is preferred, but if they are dancing around the answer or don't exactly know how to respond, you'll have to be more direct. Remember, them denying something can be just as important to your exam as them confirming something.

The questions Brandon hit on are great general questions for most patients. However, the bulk of your questions are going to be specifically tailored to each individual patient. OP, in regards to your request on specific questions, the most helpful thing for knowing what questions to ask is knowing what to expect with different illnesses. If you get hung up, your OPQRST mnemonic can help jog your memory. Thinking about the presentations of different illnesses will be more beneficial to you than firing off a list of pre-scripted, hollow questions, though.

Your physical exam is going to be of limited benefit if you haven't already talked to your patient. Even when you find their RLQ abdominal pain on your physical exam, you still have to talk to your patient. Going straight to your PE and writing off your patient as stupid or ignorant will serve you both poorly.

If Angel sends you the list that she has, do yourself a favor and go through each individual question and think about why you are asking it for that particular complaint. Again, if you know the why, it will be much easier to remember than memorizing a depersonalized script.

Arrow's remark about alcohol is true, though- if not understated :lol:
 
Physical findings are pretty sensitive for badness, but they're usually not specific, especially not early.

In other words, you will eventually notice the tanking blood pressure, but you might not have a clue why it's happening without the history... and the history is how you might have clued in before their blood pressure tanked.

For our purposes, usually patients tell us what's wrong with them, the exam tells us how bad it is. If they can talk.
 
MonkeyArrow said:
And remember, if someone says that they have had X amount of alcohol, they probably have had twice that.
Click to expand...

"i've only had two beers!" says the man who blows a .32 :lol:
 
Robb said:
"i've only had two beers!" says the man who blows a .32 :lol:
Click to expand...

Last night I had a patient tell me this who's blood ETOH was 547... I'm amazed he was still talking at all
 
TransportJockey said:
Last night I had a patient tell me this who's blood ETOH was 547... I'm amazed he was still talking at all
Click to expand...

Dude if you're coming this way brace yourself. The 'Mucc might not get them as often but we've got a fair share of fivers here.
 
This is all very helpful! Thank you Brandon for posting those questions.
 
Brandon O said:
A few goodies that aren't always emphasized in class but bear great dividends:

-- How does your chest feel? (exactly those words)
-- Have you ever felt this way before? (or if there's something salient in their history, you can specifically ask if it feels like that -- better, worse? etc)
-- How have you been feeling recently? (that is, before the current event)
-- When's the last time you were in the hospital? (good follow-up to the previous; many people will say "fine" but it turns out they were hospitalized last week)
-- Who called us? Why did you call us? (when the patient either denies any complaint or has ten thousand complaints and you can't figure out what actually prompted concern today)
-- Any changes in your diet or medications recently? Been feeling any fever or chills? Still going to the bathroom? Any changes there? (good general high-yields)
-- What do you mean when you say "dizzy"? Like you're lightheaded or like the room is spinning? (for "dizzy" calls)
-- Anything else bothering you? (nice catch-all wrap-up once you've sorted out the main complaint)
Click to expand...

Right on. Add :"Point to where it hurts, draw a circle around it with your finger".

But in my world, getting meds and allergies is #1. You can work s/s even if the pt is unconscious, but you can cause iatrogenic harm if you are ignorant about what your intervention will interact with.
 
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MonkeyArrow said:
You will quickly figure out that most of what a pt. tells you turns out to be useless. They don't know their medications, their previous diagnosis, what their past hospitalizations are for.

My 2 cents is to start the physical exam as quickly as possible and be on the look out for signs of previous medical procedures (IV sticks, scars on the chest). Ask whatever questions you want to ask while examining the pt.

And remember, if someone says that they have had X amount of alcohol, they probably have had twice that.
Click to expand...

MonkeyArrow's Rule of ETOH!!
Right up there with "But I only turned my back for a second!!".

Unfortunately, very true observations.
 
In a similar vein, no matter how long someone was actually unconscious (syncope, seizure, concussion, etc), bystanders will always describe it as multiple minutes. When translated from "bystander time," this is the equivalent of about ten seconds.
 
And almost any change of consciousness , especially with uncertain and jerky movements, is a "seizure".
 
I can also add this (that I picked up from another forum): S.O.C.M.O.B.

If you work the inner city or the rougher parts of town, you will probably know what I'm talking about.
Standing. On. (Street). Corner. Minding. Own. Business.
Most often used when a shady character is describing what happened to him and how he got shot.

Also, "some dude" shot me, but "two dudes" beat me up, since they're tough guys. And from the same forum, the first quote of my sig (well, and, the second one applies too).
 
"Have you traveled outside the country recently?"

But I work in an area with 3 major airports, a major theme park, miles of beach and a huge seaport. Lots of people travel through NJ.

Maybe not so applicable in South Jabip
 
"Are you taking any prescription medications" should be rephrased as "Has your doctor told you to take any pills, and do you take them like he/she says"

Patient history can be like a criminal interrogation sometimes.
 
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