Obtaining Medical History (SAMPLE) Flashcards
What does the S stand for in SAMPLE?
Signs and Symptoms
Signs include any medical or trauma assessment findings you can see, feel, hear or smell. For example, seeing an open wound or feeling skin temperature.
Symptoms refer to what the person reports, for example, “I’m having trouble breathing,” “I have a headache” or “My chest hurts.”
For further symptoms, ask the person to describe the current problem. Ask questions such as:
1. Where do you have pain?
2. Are you feeling nauseated?
3. Do you have a headache?
4. Are you having any difficulty breathing?
What does the A stand for in SAMPLE?
Allergies
Ask the person whether they are allergic to any medications, food or environmental elements, such as dust, pollen or bees.
What does the M stand for in SAMPLE?
Medications
Ask the person questions to determine whether they are currently using any medications, whether prescription or over-the-counter (OTC).
Ask additional questions such as:
Do you take any vitamins or herbal remedies?
Have you taken someone else’s medications?
Did you take any recreational drugs?
Are you using any medication patches?
What does the P stand for in SAMPLE?
Pertinent Past Medical History
Determine whether the person is under a health care provider’s care for any condition, if the person has had a similar problem in the past or if the person has been recently hospitalized or had recent surgeries.
If the person is female, ask if she is or could be pregnant.
What does the L stand for in SAMPLE?
Last Oral Intake
Determine when the person last had something to eat or drink and what it was.
Ask if the person has recently taken any medication, and if so, what.
What does the E stand for in SAMPLE?
Events Leading Up to the Incident
Determine what the person was doing before and at the time of the incident. The events leading up to the incident could help identify the mechanism of injury (MOI) or nature of the illness.
The MOI is defined as the force or energy that causes a person to be hurt.
