LOCQSMAT Flashcards
What does LOCQSMATT stand for?
Location Onset Chronology/timing Quality Severity of Sx/ADLs/OPS Modifying factors Associated Sx Treatment (previous) Tx goal
What is the first question you ask a patient?
What brings you in today?
What questions would you ask for location?
Where is your Sx? Point to it.
Does it radiate into extremity?
What questions would you ask for onset?
What caused your injury?
When did it happen?
Was it gradual or sudden onset?
What are the 3 scenarios that show up with patients? And how do you question each category of patient?
1–they know when and how their injury happened (usually trauma cases): find out all about the biomechanics of the trauma, how hard was trauma, Sx at time of injury, follow the patient for the next 8-12 hours, was it work related (worker’s compensation)
2–they know when it started but not sure what caused it: explore possible trauma, change in exercise, change in job, new/unusual amount of activity around the house, unusual amount of stress?
3–doesn’t know when it began or what caused it: so prob for life changes that may have caused issues in the days or weeks preceding—changes in work, hobbies, exercise, lifestyle, stress, eating habits?
What is the first question to ask about chronology/timing?
Are the symptoms constant or intermittent?
If the patient says the Sx are constant, what are the next questions you ask?
Is it 24 hours a day?
Does it prevent you from sleeping?
Try get patient to estimate what proportion of the waking day the Sx are present.
If the patient says the Sx are intermittent, what are the next questions you ask?
Is it associated with specific circumstance—foods, activities?
Frequencies and duration of episodes
After you figure out if Sx are constant or intermittent and you’ve asked questions pertaining to those sections, what other questions in the chronology/timing section would you ask?
Diurnal patterns (worse in AM? PM?)
Night pain
Getting worse/better/same
Prior history? When? How long? What did you do?
What does Q stand for and what questions do you ask?
Quality of pain
Describe the pain or Sx.
What does the S stand for and what are questions to ask?
Severity of Sx/ADLs/OPS
- Is this causing you to miss work? Affect performance? Affect hobbies, exercise, sports? Affect taking care of themselves/home activities?
- Record specifically.
E.g. put on shoes 5/10 PSFS - What is your level of pain now? Worse? On average?
What does the M stand for? What are questions you’d ask?
Modifying factors
What increases the Sx?
What makes it better? Avoiding what? Changing positions? Rest? Medication-how much/how often?
What does the A stand for? What is the first Q to ask?
Associated symptoms
Do you have any other Sx or problems you feel are related?
If they came in with neck or back pain, what associated Sx might you ask about?
Numbness, tingling, weakness in extremity
If they came in with low back pain, what associated Sx might you ask about?
Numbness, tingling, weakness in legs
Changes in bowel habits?
Bladder habits?
Change in sexual function?
Change in menses?
Does your back catch or get locked?
If they came in with head trauma, what associated Sx might you ask about?
Headache
LOC
Visual changes
Changes in mental function (clear thinking, memory, concentration)
Change in affect (personality change, anxiety, sadness)
Sleep (trouble sleeping)
Nausea/vomiting
Dizziness/vertigo/loss of balance
Sx in arms and legs (numbness tingling weakness)?
When did each Sx come on after trauma?
If they came in with neck trauma (e.g. wad), what associated Sx might you ask about?
Same as head trauma PLUS:
TMJ pain
Trouble swallowing
If they came in with inflammatory arthritis, what associated Sx might you ask about?
Rashes
Other swollen or stiff joints
What constitutional symptoms do you ask about in the A section of LOCQSMATT
Fever, malaise, fatigue, weight loss/gain, loss of appetite
What do the TTs stand for? What kind of questions do you ask for these?
Previous treatment
- who, when, what tests, what diagnosis, what treatment, did it help
- relevant injuries/x-rays, when, what happened, eventual outcome/residual effects
Treatment goals
- what is the patient’s tax goal?
- if long standing, why now?
What is the last question you’d ask?
Is there anything else you can tell me about your condition that I have not asked?
What are questions you want to ask about in the case of a MVA?
Number of vehicles involved
Major vector(s) of the impact (rear-end, front-end, T-bone, multiple impacts)
Patient position: head position (turned?); body position (front seat back seat? body
turned?)
Magnitude of trauma (speeds, size & make/model of the vehicles, amount of damage, or any other measures of force like the glove box flying open)
Force amplifiers on the neck (seat belt, foot on brake) and dampeners (air back deployed, seat broke, headrest position?)
Did the patient brace expecting the impact (more force goes into muscles); or caught unaware (more force goes into ligaments).
Police report? Witnesses?
Road conditions
