NREMT EMT 3: Secondary Assessment - Pain Assessment, OPQRSTI, Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time, Interventions

What This Is: Pain Assessment (OPQRSTI)

Pain assessment is a crucial step in emergency care. It helps us understand the nature and severity of a patient's pain, which guides our treatment decisions. Think of it like trying to diagnose a problem with your car – you need to identify the symptoms (pain) and their causes (injury or illness) to fix the issue.

Key Steps / Core Facts:

• Onset (Time): When did the pain start? (OPQRSTI) - This helps us understand the progression of the injury or illness. Example: "The pain started 30 minutes ago" (30 minutes).
• Provocation/Palliation (What makes it better or worse): What makes the pain worse or better? (OPQRSTI) - This helps us identify potential causes and treatments. Example: "The pain gets worse when I move my arm" (red flag: possible fracture).
• Quality (Description): What does the pain feel like? (sharp, dull, burning, etc.) - This helps us understand the type of pain and potential causes. Example: "The pain feels like a sharp knife" (sharp pain).
• Region/Radiation (Location): Where is the pain located? Does it spread to other areas? (OPQRSTI) - This helps us identify potential causes and areas to examine. Example: "The pain is in my chest and spreads to my arm" (red flag: possible heart attack).
• Severity (Intensity): How bad is the pain? (OPQRSTI) - This helps us understand the patient's level of distress and guide our treatment decisions. Example: "The pain is an 8 out of 10" (8/10).
• Interventions (Treatments): What has been done to treat the pain so far? (OPQRSTI) - This helps us understand the patient's current treatment status and potential allergies or sensitivities. Example: "I've taken 2 acetaminophen tablets" (2 tablets).
• Mnemonic: OPQRSTI stands for Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, and Interventions (OPQRSTI).
• Red flags: Look for signs of severe injury or illness, such as difficulty breathing, severe bleeding, or loss of consciousness.
• Normal pain: Pain is a normal response to injury or illness, but severe or persistent pain can be a sign of a more serious issue.
• Pain scales: Use a pain scale (0-10) to help patients describe their pain intensity.
• Communication: Ask open-ended questions to gather more information about the patient's pain.

What Laypeople Can Do:

• If someone is in pain, ask them to describe the pain using the OPQRSTI method.
• Offer to get them a glass of water or a pain reliever (if allowed by medical professionals).
• Stay with the person and keep them calm until help arrives.
• If the person is experiencing severe pain or difficulty breathing, call 911 or your local emergency number.

Common Mistakes:

• Mistake: Failing to ask about the patient's pain history and current pain level.
• Fix: Ask the patient to describe their pain using the OPQRSTI method and use a pain scale to gauge their pain intensity.
• Mistake: Assuming a patient's pain is normal or not taking it seriously.
• Fix: Recognize that pain is a normal response to injury or illness, but severe or persistent pain can be a sign of a more serious issue.
• Mistake: Not documenting the patient's pain assessment and treatment.
• Fix: Document the patient's pain assessment, treatment, and response to treatment in their medical record.

Quick Practice Scenarios:

1. A patient comes in with a severe headache and says it started 2 hours ago. What should you do first?

Answer: Ask the patient to describe their headache using the OPQRSTI method. Reason: To understand the nature and severity of the headache.

1. A patient is experiencing severe chest pain and says it radiates to their arm. What should you do first?

Answer: Call 911 or your local emergency number. Reason: Chest pain can be a sign of a heart attack, which requires immediate medical attention.

1. A patient is in pain and says it gets worse when they move their arm. What should you do first?

Answer: Ask the patient to describe their pain using the OPQRSTI method. Reason: To understand the nature and severity of the pain and potential causes.

Last-Minute Exam Cram:

• Normal vital signs: pulse 60-100, blood pressure 90-140/60-90, respiratory rate 12-20, temperature 97.7-99.5°F (36.5-37.5°C).
• Normal pain scale: 0-3 (mild pain).
• Agonal breathing is NOT normal breathing – start CPR.
• The OPQRSTI mnemonic stands for Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, and Interventions.
• Red flags for severe injury or illness include difficulty breathing, severe bleeding, or loss of consciousness.
• Always document the patient's pain assessment, treatment, and response to treatment in their medical record.
• Use a pain scale (0-10) to help patients describe their pain intensity.
• Ask open-ended questions to gather more information about the patient's pain.
• Recognize that pain is a normal response to injury or illness, but severe or persistent pain can be a sign of a more serious issue.