Transcript

0:10

Welcome. We're gonna go into the sample and OPQ RST. And those are pretty that that becomes an emergency and in the patient assessment, in the field, we've you've done this, I've done this, and I just wanna I guess let me say one thing. It's in the chat area. Doctor Harper, if you just put a message for anybody coming in, just find out where everybody is from.

0:34

Feel free to put that in the in the chat area, if you would. It'd be great to see where is you're hearing this, just tap where you're from in your job setting. This helps us to provide some context through that. So, Doctor. Robert, if you don't mind typing that in there, everybody.

0:49

So so we'll go ahead and get started. So, again, details are in the questions, and we wanna think about is a quick review what this looks like. And also, just trying to the hard part gets into, you're going through an assessment where you get it, when not to get it, what to do, kinda quick things as well. So some of the this will be a review for the most part, but it's always good to have a review of the basics. So we're doing the basics well, and I I would like to let's go back to your basics, and you gotta do those well before moving forward to anything else.

1:23

So First off, I'm gonna see we got some folks all around. Good to see you on here, Jim. Also, both Oklahoma and Michigan and Tennessee, New York as well, and also with an up in Mankato. So, by the way, I had a great visit up there back in November with Mankato with the university there. They do some work things there as well.

1:52

So so the the objectives excuse me. Disclosures you saw those as well. And then also, we're gonna talk about the see what the objectives are as well when we're looking at what we're gonna do, and really it's about communication. This is a big thing that we focus on. Think is how you communicate that verbal and nonverbal communication.

2:13

And then think about some just basic pitfalls that we're gonna move into. So let's see here. So We use this for all of our presentations, and it's one slide. It may look kind of busy. But with a lot of information, but just kinda kept you to kinda go through this process of what we and everything is process oriented in any patient assessment.

2:38

You know, it's just like pulling that drawer out. One thing I learned when I was when I first started 30, you know, 35 years or 30, 35 years ago, the my athletic trainers taught me, okay. It's a filing cabinet So you pull this out, you pull the file out, and then you go right down in line as well. So with what we look at here. So when you see these, we're go through the initial set up, the scene scene size up, the primary assessment you're thinking about, things you may ask, you know, during that time period, also, we're getting into patient assessment.

3:10

But today, we're focusing on the secondary assessment. We're gonna get that sample and OPQ RST, and depending on the type of situation we're dealing with is when and where we get that information, how we meld that together into a consistent history. Do we have a good understanding of what is actually going on with the patient? And, again, Nope. Nothing's left missed.

3:35

And we're not missing anything in the questions. So, obviously, we've seen situations like this. You've been in this as well before. And the big thing is it's controlling the scene, and it goes along the tempo of who you are now. There are different, you know, schools have thought on this, you know, and and I I I don't know if it's because I've gotten older that don't run this fast.

3:58

But the one thing I've learned is that you can your the time you're spending there is your you know, without sprinting on the field, one is I've seen I've seen slip fall. I've slipped my self before. So we're kind of moving back into being we're having a deliberate pace and a cadence. And that controls the situation, but cause. If you're even even though an athlete is down, like, in this picture, if you're you are a a a consistent, a jog, etcetera versus a sprint, you're now able to process what's going on faster and being controlled.

4:32

So, again, re introduce yourself and especially, you know, they know who you are most times, but if you're not, nowhere that looks into. Especially if you're working an event where you're not familiar, that's probably the 2 different times also a cadence standpoint that I'd be looking to. So if I was working with a team all the time, they knew who I am, people are familiar with who I am, etcetera, versus if I'm at a a soccer tournament, they don't know who I am, I'm gonna be deliberate, but not necessarily run out unless I see there's a a significant trauma situation, you know, compound fracture or something along those line that that definitely we we can see is pretty obvious. So again, gain consent, especially if a minder, and even for an adult, hey. So if you don't know who the person is, hey.

5:18

Introduce yourself very simple. And, you know, just we talk about using, you know, establish a commonality. Make them feel comfortable even though it's a very stressful situation and and abusing the situation. The typical times people wanna come in and help. And you you can use them, but you don't have to practice through that process of how they use that.

5:39

That may take some scenario work separate from this, but also the, you know, maven that basic contact, just be general with that based on who they are, on a shoulder to the side. You know, I'm always I just speak proponent of blocking. I'm gonna stand to the side here because I'm not if I'm here, like we see here, I'm forward and direct with you versus I'm in this position here. So a little bit it's more of a a comfortable position. So I like to use this analogy.

6:07

You know, you got chickens, you got geese, and, you know, if it walks like a you heard the phrase, like a walks like a duck, you said the duck geese, etcetera. So If you if it walks like a duck and talks like a duck and eats like a duck, then most likely it's a duck. And that's what I think that from a history standpoint. So if you see something that looks unusual, or you lose you, like, that doesn't look like a duck, then or, you know, or maybe a chicken. This one, your level sufficient gets amplified a little bit, and you're trying to think about him to think through those processes.

6:37

So here, just briefly, the sample history one giving the symptoms, what hey. What's going on? Just that's very open ended type of question. It it gives them control to tell you what's happening. The difficulty is is, obviously, if someone is having an issue with their their not wanting to provide information, then that becomes a little bit more difficult.

7:03

Not that they can't, but they're they're just being apprehensive in their own pain. Again, they're calm down. Allergies. Knowing any of the medications that may have taken or any other types of things will happen, any medications, even supplements, etcetera. Past medical history.

7:18

Again, what else has been going on? Have you had this problem before moving on down the line? You know, like, for example, are they current dislocator. That may be that's a relevant history question. Think about any oral intake, especially if we think about from a standpoint of if they're getting abdominal trauma or if they are hypoglycemic, those are things.

7:42

Are they appearance of altered mental status? That's something that comes into play. And then also just if you didn't see what happened is, what happened during this time? For medical ill for illnesses or that unknown origin, this is where you really have to backstep. Maybe 12 to 14 hours even, you know, like, for a morning or for high school, they're typically not good about eating well.

8:05

So those are things you wanna think about. So I thought though this kinda quick scenario, a couple of questions in as we move in. And, again, if you have questions, just make sure you pop them in the chat We'll we'll get to those in the last couple of minutes for this as well, and then I'll be looking them as well. So we've seen this. So, you know, you as a you as an athlete trainer could be the the EMT or whoever's, you know, coach, student, etcetera.

8:33

Think about what they're saying. You know, hey. You know, I'm you're hey. I'm so and so. Just tell who you are, and they know who you are, but they don't.

8:41

Just let them know who you are, very you know, or kindly, I see your whole new stomach. So what's going on? That simple question opens the door for them to to invite them. You're inviting them in to ask to answer anything. So it just starts at the first quest.

8:56

If you get one question out, then you can move to the next one. Regardless of where it is in the sample process. They may say, you know what? I've ate something, and I think I've got food poisoning. That's the first thing that comes out of the out of their mouth, then you have to backtrack around some other things as well.

9:14

Okay. So we'll scale 1 to 10. We that's one of the most common things we use. It's about a 6. But, you know, make sure we're Tim's the most pain.

9:22

One's 9. Oh, it's about a 6. So at least gauging that, what pain looks like, and then you're able to see that as well from facial expressions. So if I said, you know, I'm having this and and you asked me this question and you and I would say, well, I have a 10 and you see my facial expression now. That looks that goes back to that duck and chicken I've mentioned a minute ago.

9:45

It definitely is something off. And I've probably seen that probably twice in 25, 30 years, and and one was an ankle injury, and it was like, okay. On a scale of 1 to 10, oh, it's about a 9 to 10. And had no facial expression, no nothing, really wasn't limping. It was kind of a weird situation, you know, how it came about, but you know, and doing special tests as well.

10:08

So this thing about that when you look for medical and for trauma. You know, let's go through some of the questions. Into what's going on, especially if if it's if if they're calm. So you're trying to move through that process. Any unusual or medications today, they said pregame meal, think about any other similar pain moving forward is also.

10:27

So think about also, you know, does the pain how does the pain move? And this gets This question here at the top is probably a little bit more of a it's not necessarily an open ended question, but you you're trying to delve into you're not telling them, hey. Does it hurt when you raise your arm or breathe deeply? So that's kinda the same when breathing is. But if you say, hey.

10:49

Just hurt when you raise when you move your arm out, then you're you're prompting them, which you wanna be aware of, and just maybe not do it. Let them tell you where it hurts is usually better. Any of the symptoms, injuries, past pertinent history, and then looking at this. So this gets a you have time to ask those questions. But, again, all the while, you're still trying to move to this process versus we move into the more the more rapid questions.

11:16

We've gotta get down to really, it focuses on pain. What's the problem? What what's the pain? And why are you having this issue? So onset is when did it start to start?

11:26

What pain ties into symptoms. What makes it better? This is like one of the best questions that that, you know, we all learn early on in history taking is what makes it better, what makes it worse? Well, it makes sitting down or standing up or laying down, etcetera. Let them describe the pain, and they don't, you know, try there are many prescribers or I'm so sorry.

11:51

Descripters of pain, but these are sharp, dull, robbing, persistent, pulsating, that Gong gives that based on and then and you can ask where it position if it probably is it provocative in a certain position to what that may be different pain. Whereas the locating pain or if it's radiating or any other indirect area as well, think about using pain scales, or if you have a visual card, you can use, like, a visual analog card for the and for pediatrics and and for youth having a a a smiley face severity scale or or that that looks like. Those work real well also in helping just to how they can point and identify that, and then also what the frequency are. So, again, goes back into really quick questions. Tell us about your pain.

12:41

Tell me when it give me get a clear picture. Let them they're gonna take when it happened when it started. It may have started 10, 15 minutes ago. Or taking more deep breaths, and you can see that what that looks like in trying to do a provocative testing just like we would do for a special test. Again, think about where the radiating pain have them to describe it.

13:03

If they can show it, it's even better. Let them be be in control of that situation. So that kinda gives you an example of what that looks like. So with the the hard part is is you gotta have this step by step approach move through. You can still jump or some jumping around based on questioning And typically, what what I do and works real well is simply go through the line of questioning based on the type of severity, what type of condition it is, and where it is from the from the process of moving through this initial assessment, like the initial screen I showed you, seeing size up.

13:43

I'm going through my my processes and with that not getting off track because if you do, you miss something potentially. So Again, make sure you're not missing critical information. If you go back and you ask a question and update and done this and I go back and so tell me, I'll back this again. You're just going back and look do a double loop just to get the question. Now I'll come back and now reconfirm it.

14:08

Especially if I'm not certain about certain things as well for being perplexed. Stay consistent in your tone, your manner, your approach, etcetera, you develop that rapport of how you do that, work with a patient. And then you gotta validate your history findings. I'm we talked about that in a second how to do that. So when we look at this, this is just a simple chart that if they're alert and conscious, that's good.

14:36

That's but you still have that caution. You know, walking on the wet floor. You know it can happen You know it could get worse because it can get slippery, you fall. But again, until you prove otherwise, you still maintain caution versus a person you think about AppCute Look at AppCute Scale. They are alert and conscious or they don't they they only respond to verbal.

14:58

Or they're pain or they are unresponsive at those point in time, and then you're you're moving into a this is a load and go situation regardless of whatever it is. And so the other thing when you look at alert and conscious, well, they are, but are they confused. And that's That's the area where I probably lean more. Okay. We need to do move to the right and move that rapid assessment to make sure not deteriorating rapidly like, for example, an epidural hematoma, for example.

15:27

So we're gonna go through we're gonna get the quick questions Moving through the OPQ RST process, we may have and then with the sample and, again, some of the sample, you're you can modify that based on what's already been instruct what you've found, or you may get that on the very onset. They may tell you something or a bystander may say that. Moving through again, going through the assessment, you're gonna then take vitals because it's not really in a lot of times, like, for an orthopedic ankle. We're not doing full vinyls. There's not a need to do that, but we still need to make note of those those items skin color temperature on our on your follow-up report or at least your final report what that is.

16:10

It's always important to know that they have neurological status. They're oriented. And what that look those basic things as well that because in as you know, from a legal standpoint, if you don't document it, it did not happen. And so those are just common things to think about versus that loan go. We're doing a rapid assessment Head to toe assessment.

16:33

Doctor Harper's gonna cover that in a little bit, but we've gotta get to that process. We gotta figure out what's happening. And then make sure we're not missing something, do vital signs, determine the status. We've gotta put them in the correct position, appropriate position, obtain the his what history we can, and we're transporting. And that decision's already we're moving up probably more rapid.

16:53

We know that this is a transport position. We've already made the call, but we're waiting in the transport process. So what are the, you know, what are keys to effective open ended questions? Obviously, start broad, and then you can focus in. Capture what you can still eliminate a lot of information based on that.

17:12

The simple thing of simply, hey. So tell me what's going on. And that will open the door for them. You're inviting them. It's not aggressive.

17:20

It's it's it's very nonspecific. But, again, it gives them to just start ask you answer the question. Keep it simple. Use simple language if you know, even to practitioners, we think all gonna, you know, do medical. You know, just be simple and get this get info as much as you you avoid having to backtrack and get an explaining explaining information versus that as well.

17:46

Be the active listener. Ask a question. Be attentive. Don't look at a phone. Just eliminate other distractions.

17:55

Where you can. If somebody's in the background and they're moving and you see the athlete's eyes are, you know, moving around, turn them into a position where they're not looking behind you. They're not focused on the game, etcetera. Keep them focused on you, but also it helps you them to be a active honker with that as well. Repeat with reflection.

18:13

Think ask them, hey. So tell repeat what happens. So this is correct, and let them validate what you understand because it still not may not be there. Give patient the time to talk. Don't interrupt.

18:26

Let them talk. Silence is good. To the point where they're not just they're not talking and you're not getting a response otherwise. And then at the end, you're gonna clarify and summarize. Basically, you're doing a handoff to yourself, like we talked about the EMS, emergency situation, We're handing it off to yourself.

18:45

Here's validating, so then you can come back and have the the right information on the notes once it's entry notes on the off the field. So what are 7 signals we think about of underlying conditions? Anytime altered mental status is an issue, that's a problem. If they're if it's the worst pain they've ever felt, you need to think about that being it's pretty serious. It may not look like it.

19:08

But that's that that level of suspicion that we have to until otherwise proven, we need to be more cautious than that. If they cannot breathe, they're they're potentially becoming hypoxic. So we need to be aware of how we're going to assess vitals, wrap get them into control. Son of skin and also skin, you know, sweating, cool, clammy, temperature as well. If they change rapid history and history symptoms, that becomes problematic.

19:38

If they're saying this and it gets worse in 5 minutes, even though they may not be showing that initially, it means they're spiraling out. It could be decompensating at a very rapid rate. So for pediatrics, or that becomes even more important because they get they will they will they're fine until they're not. So they become a say, at a much rapid more rapid rate than you see in the adult, especially in term when we're talking about shock or abdominal injury or bleeding, etcetera. Something just isn't right.

20:07

And just use that or I give it duck analogy. If they're saying this, it doesn't, this is a case. With all this one, this is a quick anecdote to this is about 10 about 10, 12 years ago. I was working at high school, trying to meet, athlete comes over midafternoon, like, 3:34 o'clock, having really head pain. They're a lot of, you know, they're laying on the ground.

20:29

I go approach them. Person's responsive talking of a hairless set up. As soon as I set them up, they start getting worse headache, pain, etcetera. I'm like, This is not sound right. So I'll take vitals, lay them down, ends up.

20:43

That the one thing was when we would move the person, it their pain became greater, vastly greater. But vital signs were basic they're normal. There were not nothing no outlier. Nothing ended up having had to have a emergency surgery for an aneurysm. So so which was from that standpoint, so just follow your gut instinct.

21:08

Then think about unusual behaviors as well. One of the last things here, considerations for the any if you're working, like, special Olympics or other events as well, be aware that know that, you know, beforehand, identify who that may be or if there's a patient advocate or other techniques, especially for sign language as well. So my sister and brother-in-law have both worked with losing a school for the deaf, and I've worked some events with them. So we have someone who I'm I'm I am not proficient in any way of sign language. But you can at least read someone's, you know, facial expressions, you know, understand what they're going through.

21:45

I said, like, the universal language of not they can see what that pain is. Having an having a sign language interpreter, also, they're cognitively impaired. Think about what that how you're gonna approach that, but also think about technology. If you have a a just a general language barrier, pull out something like Google translate, and they can you can then move to that process to help with that as well for that. Last thing, again, Think about the comprehensive assessment.

22:14

Be aware of that. Communication is so critical in this process. How you communicate. Does your body language, your tongue, how you approach them is and also for others around them, Think about the pitfalls. You're trying to improve outcomes.

22:33

Also, look at technology integrations. There are a lot of different things out there now. That you can help in speed to process up and become more efficient than that. You have to continually practice, and then also The early quality assessment of spurts 2 to 3 minutes improves that hand off, especially into critical situations to EMS. So that's all that I have.

22:55

And then this lady with this quote from Ward Bember, command US Navy Seal Commander, One of the things we hear this is calm is contagious. And you can implant any words or plant any word for that if it's panicked. It becomes more it it exacerbates. So if you're panicky or you're nervous, people see that, they feel that. And just have to be aware of how you have that deliberate process moving through in in any situations.

23:24

So Any questions when we get moving or get done with this first session? Thank you.

23:32

Good. Righty. So right quick question. OPQST sample. You clearly broke each down.

23:41

Can you start with OPQRS 1st in in sample, or can you start with sample that OPQST, and then can you blend all those letters together to make your own cadence?

23:52

You know, the every situations could be a little different because you're getting they they may be telling you something first before you even get it out. Like, they're they're starting to rent somebody's giving you that history initially. The best thing to do is to stay with OPQ RST. It's just that's the first That's the most important thing is there. Pain, pain, what's the onset that you go through the timing, the provocation.

24:15

It's gonna typically tell you those things as well. Then you delve down into, okay, why are you why is this is how long is going on, but why is it happening? Like medications, last meal. It's a second layer of understanding what the problem is, and now I need to get really down to the higher lot big things that may take a look and also it may take longer is identifying what the pain is. If the person is is not having like, have an altered mental status, and they're you know, no one's there to respond to they're not able to talk with Will.

24:49

You're using that as your basis for you need how you're going to treat that person. If they can't, like, nonverbal, nonphysical, not movement, those are things that they're responding to pain, Again, it goes back to OPQRST. How long it happened? You gotta get the base information without the person who didn't say anything.

25:08

So why is it relevant to gather information like allergies, last meal? Like, it's even though it's not really relevant to the potential case in point, who is that information potentially for? Who when does it become relevant? That kind of information?

25:28

Well, I think it's all I mean, I think it's all relevant from a standpoint of if if someone has an entrepreneurial status, you wanna that's one of the first questions you would ask. It's a very simple question. When did you last have any type of oral intake just from a standpoint of energy, like, if if they're hypoglycemic or if they've had or if they are too much that you're you're eliminating something very easy, which means you go into okay. I'm gonna do a I'm gonna do a CBG. And now I've ruled out the sugar issue.

25:60

That's that's kind of a easy thing that could easily be treated when it looks at something else. At the end of the day though, it's really important cause it they're having a significant medical issue, for example, and a possible appendicitis. Or an epidural rupture appendix. Well, knowing when they ate, what medications gonna be critical, especially if you're going into surgery because that's gonna delay the process success as well. So they have to actually take additional steps for that.

26:30

So those things are all critical, the timing, and, again, you whenever you can get to those questions, begin get the first OPQ RST out of the way, that's initial thing, and then you get those other questions as well because it's gonna come import it down the line for them.

26:47

No. When you do a you're ready for your hand off report and you communicate with DMS, If you don't communicate in the in the OPQST sample framework, if you don't give them that information, they're gonna quickly kinda discredit you because that's the language that they talk. That's the information they want. So it's important that you understand that you're systematically collecting information and then transferring that information as well.

27:14

Yeah. In in EMS, they'll use typical form. We don't use a soap note. They'll they'll use a call it a I chart or chart. CHART, and it goes back down very deliberately.

27:24

Those things are interventions and treatment, things like that as well. So they they're thinking in that mindset. So from a Mercy standpoint, it's I found that it's a lot easier to capture those things in that looking at a sample chart with how it's done, it helped me get a little bit better, I think, more efficient in my note taking But then you have soap notes as more follow-up progress report, like, for rehab and stuff like that, where chart is very specific. What's the chief complaint? What's the history?

27:56

What are the activities leading up to it? And second, move on down the line.

28:01

Sounds very good.

28:02

And it helps to systemize that when you break it into that 32nd, 34 second response. I mean, the the hand off you mentioned, they only want the