How to use SAMPLE history as an effective patient assessment tool
Use SAMPLE history to assess the patient's complaint and make treatment decisions
SAMPLE, a mnemonic or memory device, is used to gather essential patient history information to diagnose the patient's complaint and make treatment decisions.
Like OPQRST, asking these SAMPLE questions is the start of a conversation between you, the investigator, and the patient, your research subject:
1. Signs and symptoms
4. Pertinent medical history
5. Last ins and outs
SAMPLE questions are asked of any patient. Though if a patient has airway, breathing or circulatory life threats the gathering of patient history is secondary to treating those life threatening conditions, like removing an airway obstruction or performing chest compressions.
The results of SAMPLE can help identify the cause of a medical condition, like anaphylaxis secondary to ingestion of an allergen. The questions can also help diagnose a reason for traumatic injury. For example, alcohol consumption might have caused a fall and fracture, as well as potentially predicting respiratory depression and airway compromise.
Here are some tips on how to best approach using SAMPLE history during the secondary assessment.
Signs and symptoms
Signs are what you can measure, such as heart rate or respiratory rate. Signs are also what you can hear or see. You can auscultate wheezing or see a bruise. Symptoms are what the patient complains about. Symptoms are the patient's subjective description of their illness or injury.
Robotically asking a patient, "What are your signs and symptoms?" will either result in a blank stare or a long narrative of a complex and confusing medical history. If you haven't asked or been told already, ask the patient or their caregiver, "Why did you call for an ambulance?"
Sometimes the reason for EMS is self-evident, like a deformed extremity, a patient clutching their chest or audible wheezing. Other times you make need to probe to determine the nature of the patient's complaint. Use the patient's answer to ask follow-up questions about their symptoms associated with or relevant to the problem.
For patients with a pain complaint, use the OPQRST mnemonic to learn more. OPQRST, like SAMPLE, continues the conversation between the investigator and the research subject. Delve even deeper into the patient's chief complaint to identify the presence of associated signs or absence of pertinent negatives.
Asking, "Are you allergic to any medications?" limits the patient's response to just medications. Follow-up with, "Do you have any other allergies we should know about?" Or ask a broader question, "Do you have any allergies?" or "Are you allergic to any foods, medications or insects?"
Continue the investigation by asking about the patient's reaction to an allergen. For example, do they have a local or systemic reaction?
Asking the patient "What medications do you take?" is a starting point. Ask the patient if they are taking those medications as prescribed. Also ask the patient if they use any over-the-counter medications, supplements or homeopathic formulations. If you want to know more about medications, which you should, don't hesitate to ask the patient what conditions they take those medications for or use a drug guide app on your smartphone.
Pertinent medical history
Because of the detective work you have already done, you may know from your allergy and medication questions many of the patient's medical conditions. Ask "Do you have any medical conditions or history we should know about?"
Instead of past medical history focus your inquiry on pertinent medical history. A broken ankle suffered as a child isn't pertinent for a geriatric patient with a fever, confusion and hypotension, but a recent urinary tract infection, though, is very pertinent. Use follow-up questions about outcomes of previous illness or injury to gather additional information.
Last ins and outs
Many caregivers narrowly ask their patient about last oral intake, with a focus on food eaten at the patient's most recent meal. Cast a wider net and ask "Have you been eating and drinking normally?" If yes, ask "What is normal for you?" or if no, ask "What has kept you from eating normally and for how long?"
For patients with abdominal pain complaints, asking about their last outs — urination and bowel movements — is relevant and appropriate. Frequency, color, smell and consistency may also provide useful information for patients who have a fever, gastrointestinal or genitourinary pain complaint or a recent history of abdominal or pelvic trauma.
If you haven't already, this is another chance to ask the patient about recreational or illegal drug use. Marijuana legalization is in a growing number of states, widespread availability of synthetic marijuana is being sold as bath salts, and the opioid epidemic is making drug intoxication a likely cause of altered level of consciousness and behavioral complaints.
The final questions are an opportunity for the patient to give you a frame-by-frame description of what happened leading up to their illness or injury. For a traumatic injury, better understanding the mechanism of injury might help identify additional injuries or even risks for repeating the injury.
Use the information you have gathered with SAMPLE, along with vital signs and physical exam findings, to make treatment decisions. Remember, SAMPLE findings can confirm indications for a treatment as well as contraindications, like a medication allergy, to a prehospital intervention.
Finally, don't limit the patient history taking with SAMPLE to the size of the form fields in the electronic patient care report. As a clinician, investigate the patient's complaint with the goal of making a diagnosis (yes, EMTs diagnose patients) or to assist other clinicians in making a definitive diagnosis.
What are your SAMPLE success tips or questions? Share them in the comments.