Asking the Right Questions

SAMPLE and PQRST, complaint-by-complaint question sets, and what to ask emergency services on handover.

Asking the Right Questions

It is very difficult in the beginning of your ER career to know what questions to ask when assessing a patient. The questions change by chief complaint and patient. Below is a mini guide as to what questions you should be asking. With time, these will be second nature, and you may develop a better flow or list of more concise questions to ask. There are questions that you will ask every patient and to make it easy to remember, it is the SAMPLE mnemonic we discussed earlier. We will also ask the PQRST questions.

SAMPLE (Symptoms, Allergies, Medications, Past Medical History, Last Intake, Events)

1) Allergies a) "Do you have any allergies to medications or foods?" 2) Medications a) "What medications are you currently taking?" 3) Past Medical History a) "Have you been diagnosed with any medical conditions in the past such as high blood pressure, diabetes, high cholesterol?" b) "Have you had any recent surgeries or hospitalizations?" c) "Do you smoke, Drink alcohol regularly, or use any illicit drugs?" i) When asking about illicit drug use, I find it helpful to say "We are asking to be better able to care for you, we are not the cops, we are not going to report you. Again, it is so we can have a clear picture of everything and be better able to help you." 4) Last Intake a) "When was the last time you ate or drank anything? What was it?" i) I'm only asking this question when I anticipate a patient requiring sedation whether for a bedside procedure or surgery. In the ER, I will ask for patients who have fractures as they may undergo a conscious sedation to get the bone back in alignment. (Remind them not to eat or drink anything? 5) Events a) "Can you tell me what happened?"

PQRST (Provocation/Palliative, Quality, Region/Radiation, Severity, Timing)

1) Provocation / Palliative a) "What makes your pain worse?" b) "What makes it better?" 2) Quality a) "How does your pain feel? Can you describe your pain?" i) Is it sharp, dull, aching, burning or throbbing? 3) Region / Radiation a) "Where is your pain?" b) "Does your pain radiate anywhere?" 4) Severity a) "On a scale of 0 to 10, with 0 being no pain and 10 being the worst pain imaginable, how would you rate your pain?" 5) Timing a) "When did the pain start? Is it constant or does it come and go?" *You need to ask the SAMPLE questions to every patient. The PQRST to every patient with pain.

Complaint Based Questions

1) Chest Pain a) Where is the pain located? Can you point to it? b) Can you describe the pain? c) How long have you had this pain? d) Did anything trigger this pain? What were you doing when it started? e) Does the pain radiate anywhere? f) How bad is the pain on a scale from 0 to 10? g) Have you had pain like this before? What was done? h) Are you having any other symptoms like dizziness, shortness of breath, or nausea? Other symptoms you can ask about include weakness, cough, swelling in the legs, or distended abdomen. i) Then of course, as the SAMPLE questions. 2) Shortness of Breath a) How long have you had shortness of breath? b) Is the SOB constant or does it come and go? What makes it better? What makes it worse? c) What were you doing when the SOB started? d) Are you having any other symptoms? e) Have you had any recent surgeries or been immobile for a long time such as a long car ride or flight? f) Has this happened before? Do you have a history of heart or lung issues? Do you smoke? g) Then of course, as the SAMPLE questions. i) Do note, that for your respiratory patients who are in active distress, you will be performing interventions first then once they are stabilized will be asking the questions. Like asthma exacerbation patients will most likely not be able to speak to you from how short of breath they are. 3) Abdominal Pain a) Where is your pain? Can you point to your pain? b) How long have you had the pain? Was it sudden or gradual? c) Did you eat anything that could have caused this pain? d) How would you describe the pain? e) Does the pain radiate anywhere? f) What makes the pain better? What makes the pain worse? g) Any changes in bowel habits or urination? Does it hurt to pee? h) Are you having any other symptoms? i) Like fevers, nausea, vomiting, diarrhea, constipation, bleeding from the rectum or when vomiting? i) Has this happened before? What was done? Prior GI issues, diagnoses or surgeries? j) For women of childbearing age: Any chance of pregnancy? When was your last menstrual cycle? Any vaginal bleeding or spotting? k) Then of course, as the SAMPLE questions. 4) Motor Vehicle Accident a) How fast were you going? b) Were you wearing a seatbelt? Any separation from vehicle? c) Did the airbags go off? d) Did you lose consciousness? e) Mechanism i) Direction of Impact: Struck head-on, rear-ended, struck on drivers side or passenger side ii) Position in vehicle: Driver, passenger, back seat etc iii) Vehicle damage: Rollover, Extensive damage, minor accident, vehicle intrusion, dash damage etc f) Where is your pain? g) These patients require a thorough initial stabilization and secondary assessment to ensure nothing is missed. Looking at the head, neck, back, chest, abdo, pelvis, long bones, deformities and so forth. Ensuring no injury is missed. Checking for internal injuries and bleeding, checking for sensation and strength. Vital signs. And constant monitoring and reevaluation. h) Then of course, as the SAMPLE questions. 5) Syncope and Loss of Consciousness a) What happened before it? Any Chest pain, dizziness, sob or headache prior to event? b) What were you doing when it happened? c) Did anyone witness it? What did they notice? How long were you unconscious? d) Did you hit your head? Any head neck or back pain? Loss of sensation or strength? e) Has it happened before? What was done, what were you told? f) Are you having any symptoms right now? Cp, sob, dizziness, palpitations, headache etc g) After you regained consciousness, did you feel confused or were you back to normal mentally? h) Have you been eating and drinking water? i) Then of course, as the SAMPLE questions. 6) Back Pain a) Where is your back pain? b) When did it start? c) Does it radiate anywhere? Down just one leg? i) Any numbness, tingling, or weakness in the legs? d) Can you describe the pain? e) Out of 10, how bad is it? f) Any issues urinating or with your bowels? g) Does anything make it worse or better? i) Did you take any over the counter meds, have you rested, have they helped? h) Has this happened before and what were you told? i) Any trauma? j) What were you doing prior to it starting? Did you lift anything heavy or bend wrong? k) Then of course, as the SAMPLE questions. 7) Seizures a) Was it witnessed? If so, what did they notice? b) Did you have an aura prior to? c) Do you have a history of seizures? Have they happened before? When was the last one? d) Do you take medications for it? Which one? Dose? e) Have you been taking your meds? Has there been a change in your meds? f) Did you urinate on yourself or bite your tongue during the seizure? g) Are you feeling confused? (Ask the orientation questions) h) Ask trauma questions if they fell down (Head neck or back pain? Sensation? Strength? Etc) i) Any recent sickness or head trauma? j) Then of course, as the SAMPLE questions. 8) Suicidal Ideation a) Are you feeling like hurting yourself right now? b) Is there anything making you feel this way? Any stressful events happening? c) Do you feel like hurting others? d) Are you having any hallucinations? Are you seeing or hearing any strange voices or figures? e) Do you have a plan in place? f) Has this ever happened to you before? Have you ever tried to hurt yourself in the past? g) Have you been drinking or using drugs today? h) Then of course, as the SAMPLE questions. 9) Asthma Exacerbation a) How long have you been short of breath? b) Did anything trigger it? c) Have you been using your inhaler? How often per day? i) Any recent changes in your asthma meds? d) How often do you have to come to the ER? e) Have you ever been intubated or had to go to the ICU for your asthma? f) Then of course, as the SAMPLE questions. 10) GI Bleed a) How long have you been bleeding for? b) Rectal bleeding or vomiting blood? c) What color is it? Bright red or black? d) For rectal bleeding, is the whole toilet bowl red, streaks or only red on the toilet paper when you wipe? e) For vomiting blood, how often? How much? (You can ask, how many cups?) f) Do you take blood thinners? g) Has this happened before and what was done? What were you told? h) History of esophageal varices? i) Then of course, as the SAMPLE questions. i) Associated symptoms, abdominal surgeries, meds like blood thinners, diagnosed GI issues, alcohol use and liver issues and so forth. 11) Congestive Heart Failure Exacerbation a) Do you take diuretics? (Do you take water pills?) i) Did you notice you gained weight? b) Have you been taking your medications? c) How long have you been short of breath for? How long for fatigue, leg swelling, feeling like drowning while laying flat? d) What is your ejection fraction? (Do you know the percentage of how well your heart is working?) e) Then of course, as the SAMPLE questions. 12) Hyperglycemia and DKA a) What medications do you take? Have you been taking them? b) What is your sugar typically at home? c) Did you recently binge drink? d) Any recent infections or illnesses? e) Increase in thirst? Urination? Nausea? Abdominal Pain? f) Then of course, as the SAMPLE questions. 13) Allergic Reaction a) Has this happened before and what was done? b) Do you know what could have triggered it? Any new lotions, shampoos, soap, detergents? i) What were you doing or where were you when it started? c) Have you ever developed breathing issues? Have you ever had swelling of your tongue or throat? d) Are you feeling SOB or like your throat is closing? e) How long have you had these symptoms? (Rash hives etc) f) What are your known allergies? g) Then of course, as the SAMPLE questions. 14) Stroke Symptoms a) How long have you had these symptoms? When were you last normal? What time did these symptoms start? b) What specific symptoms are you having? i) Facial droop, slurring, numbness, tingling, weakness, coordination issues? c) Check blood sugar to rule out hypoglycemia. d) Has this happened before? Did it go away by itself? What was done? e) If within window for thrombolytics, ensure no contraindications such as recent head trauma, blood thinner use, recent surgeries, recent stroke, brain lesions, active bleeding etc f) Then of course, as the SAMPLE questions. 15) Pediatric Fever a) How long have they had the fever? b) Did you give any medications today? Which ones? How much and how long ago? c) Any sick siblings or other family members? d) How are they acting? e) Are they eating and drinking? How many bowel movements and urinations per day? f) Do they have all of their vaccinations? Any recent vaccinations? g) Ask about whether the patient has had a cough, runny nose, pulling at their ear, pain with urination, or pain in their abdomen. Any wounds? h) How high has the fever been at home? i) Then of course, as the SAMPLE questions.

Key Questions for Emergency Services

• Where did the patient come from? Who is the caregiver that knows about the patient? What is their name and phone number? o Sticky situations often come out of not knowing who to contact for more information about the patient. Especially for patients who are altered. Or what if the patient is getting discharged but you have no idea where they will return to or who to contact. So when your patients are older or altered in any way, please ask for contact information. • Is the patient full code? Is there a POLST? o Especially important for patients who are older and or those who are very critical. You want to ensure you honor their wishes if something comes up. The last thing you want is to start CPR or assist with intubating a patient who codes when they were actually a DNR/DNI. • What is the patient's baseline? Mentation Baseline? o Although you can get information from the caregivers, in time sensitive situations like strokes, ensuring you ask about the patient's baseline from emergency services is extremely important. You want to know what is new from what is old as it can help guide care and or with monitoring for improvement or worsening of the patient's condition. • What medications did you give? o If the patient is coming in for chest pain, and it may be an ACS workup type of patient, did they give aspirin or nitroglycerin? Did the nitroglycerin help with the pain? For example, if they didn't give aspirin, you know you will most likely end up giving some. Or let's say the patient was having seizures and received benzo's enroute, you want to know how much and at what time. If the patient continues to be altered past the point when the meds should have worn off, then it signals other issues may be going on. • What is the blood sugar? o Checking a point of care blood glucose on altered or comatose patients is one of the ER's most fundamental steps to do to rule out hypoglycemia. So we want to ask just to ensure a check was already done, even though we will do our own. I remember I had a patient who came in crashing, and blood sugar was not checked en route, and it ended up being low in the 20's. • What is the chief complaint? o Of course, although emergency services are really good at communicating their report, just ensure that at the end of the day you have a clear understanding of what the patient came in for.

Updated 30 Aug 2026