MED-02 — Lesson 4 of 6
Integration: Building the Full Patient Picture
Combining SAMPLE and OPQRST without redundancy
How the Tools Work Together
The integration rule is simple: run SAMPLE first to establish overall context, then expand the Signs and Symptoms element with OPQRST whenever pain or a specific complaint is present. This avoids asking the same questions twice while ensuring nothing is missed.
| Tool | Purpose | Timing | Output |
|---|---|---|---|
| SAMPLE | Context: who is this person, what are their risk factors, what led to this? | First — always | Background, risk profile, resource implications |
| OPQRST | Complaint detail: what exactly is happening and what does the pattern suggest? | Embedded in S of SAMPLE when complaint is present | Clinical characterization, severity, trajectory |
| Combined | Complete patient picture for decision-making and handoff | Documented together | Drives treatment, evacuation, and reporting |
The Full Assessment Sequence
Integrated Assessment Sequence
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Run SAMPLE first to establish context, then expand Signs and Symptoms with OPQRST whenever a specific complaint is present.
For Unconscious or Unresponsive Patients
When the patient cannot answer your questions, you must gather SAMPLE from secondary sources and environmental clues.
- Bystanders and companions — What did they witness? What has the patient complained about recently?
- Medical alert jewelry — Medic Alert bracelets or necklaces may identify conditions, medications, and critical allergies.
- Medications and equipment — Check the patient’s pack, vest, or pockets. Insulin pen, EpiPen, inhaler, or prescription bottles tell you what conditions they have.
- Your group’s SAMPLE profiles — If this is a known group member, reference the proactive SAMPLE profile you built in advance.
- Physical exam findings — Apply DCAP-BTLS (see MED-03) to find signs that compensate for symptoms you cannot collect.
Scenario Walk-Through: Integrated Assessment
Apply the integrated sequence to the following scenario. Use it to practice the assessment flow before the capstone exercises in Lesson 7.
Camp Patient: Abdominal Pain, Day 3 of a Wilderness Trip
Presentation: 35-year-old male, alert and oriented. Reports increasing abdominal pain since this morning. Arrived at camp 3 days ago. Last night was the first night he had difficulty sleeping due to the discomfort.
S — Signs and Symptoms: Guarding abdomen on palpation. Pain began centrally around the navel yesterday afternoon and has migrated to the lower right side overnight.
OPQRST: O: Gradual onset, began approximately 18 hours ago. P: Worsens with movement and walking, no position relieves it. Q: Dull, cramping initially — now sharper and more constant. R: Started periumbilical (navel area), now localized right lower quadrant. S: Started 3/10, now 7/10. T: Constant, progressively worsening since yesterday evening.
A — Allergies: PCN (penicillin) — causes hives. No other known allergies.
M — Medications: Ibuprofen PRN for headaches only. Took two doses yesterday for the pain with minimal relief.
P — Past Medical History: Appendix still in place. No prior abdominal surgeries. Healthy baseline. No cardiac or respiratory history.
L — Last Intake: Last solid food: 12 hours ago (minimal — no appetite). Last fluid: 2 hours ago, approximately 500mL water. No alcohol.
E — Events: No trauma, no unusual exertion. No other group members ill. No significant changes in food or water source. Stress level moderate — stressful work situation before the trip.
Based on this integrated SAMPLE + OPQRST picture, what is your most likely working impression, and what is your immediate management decision? (Answer revealed in the Knowledge Check below.)
| Complete this lesson’s Knowledge Check to continue |
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