Temperatures

[JJR512]

It just occurred to me, more than a week after completing the part of EMT-B training related to obtaining vital signs, that there was nothing about taking temperatures. Are EMS providers (or just EMT-Bs) not concerned with a patient's temperature?

Aside from that, are tympanic (in-the-ear) thermometers really all that good/accurate? Wouldn't a lot of wax in the ear canal throw off the results?

[Stevo]

i'm under the impression tympatic is in vouge now.

butcha know, it's electronic, and electronic things shouldn't always (imho only) be trusted...

case in point, try comparing what your electronics give you to what the ER's do, or comparing to the patients #'s

this goes for pul-ox, glucometers, etc

~S~

[rescuecpt]

As far as I know most states don't have temperature-taking in their protocols. Why not? Well, what does it do for you in a prehospital setting? If your patient is flushed and their skin feels hot, cool them down. If they are cold, warm them up. If they have the flu, does it really matter to you if their temp is 99 or 102? No. You're still going to get them to the hospital in a quick, safe manner. You don't have any drugs you can give to reduce fever, and it's not going to change your other treatments in any way.

We DO assess skin, for color, temperature, moisture, etc.


Note: edited for my multiple spelling mistakes - I must have been tired!

[Jon]

Uhhh.... yeah..... I'm sorry.

a ##.# for temprature isn't really going to tell me anything. I can't give APAP anyway... so why bother? You are, as they say either "hot or not" ;).

Jon

[Wingnut]

Not to mention fevers really aren't bad things...and if they are then that's probably why ther pt is calling for us, they'd most likely call saying...he/she has a 108 degree fever. Even then we keep the pt cool and get them to the ER, there's nothing in our protocols for it either.

[MMiz]

I tell my students there are no stupid questions, but I may be asking one. I once saw a pt present with a high temp, lets say 104, I don't remember the rest. It was a average autumn day, not the heat of the summer. The patient was barely responsive. The medic started dousing her in cold water.

That just doesn't seem right to me.

[squid]

We carry thermometers, mostly to check for hypo/hyperthermia. We use it as a diagnostic tool to help rule in or out various conditions. Mostly hypothermia, of course, being as this is a pretty cold place much of the year.

Of course, tympanic doesn't really work for that, so.... I'm not sure why we use it.

[rescuecpt]

we have thermometers for firefighter rehab, but not for general patient care.

MMIZ, I had a 104 when I was 6 that held for over 4 hrs, so my doc had my parents dunk me in a lukewarm (but supercold to me) bathtub... I remember being held in there for 5 minutes and not liking it. I ended up hospitalized for the flu with severe dehydration and the high fever.

A high temp (such as 103 or 104) can cause brain damage - sometimes very quickly - so it wasn't necessarily wrong to try to cool down the patient, but my preferred method would be icepacks wrapped in gauze at the ankles, wrists, groin, and armpits.

[TTLWHKR]

Not to mention fevers really aren't bad things....

Even low fevers can cause fatal seizures in small children.

They probably don't teach it b/c it's a rather obvious procedure. And if it isn't, just go for the underarm. I'm more fond of that in anyone from infant to 18. I don't like tympanic thermometers, our ER's don't use them, and the ambulance isn't equipped with them. We have a standard console built into the rig that has an auto BP, pulse ox, and the various temperature probes.

Funny thing was, I used the oral probe on a teenager w/ LRQ abd pn, and he said it tastes funny. Well, turns out that there are two boxes of probes for a reason. One is lubricated and the other isn't... I did not know this. :wacko:

[ffemt8978]

We're equipped with the tympanic thermometers in all of our rigs, and two of them have dual function oral/rectal thermometers as well. We use them frequently, but don't treat based upon them (like pulse ox). We simply record the information and pass it on to the hospital on arrival.

[Ridryder911]

Tympanic thermometers have a poor history of being accurate. That is why physicians highly discourage the use of them. The only true accurate reading is the rectal temp gettting a "core" temp.

We carry digital thermometers for rectal temps., (if you have a 108 temp something is really wrong!) most thermometers only go to 105.

Be safe,
R/R 911

[Jon]

or an esophegeal temp

[TTLWHKR]

We got one up to 112 one night... The bulb of a mini mag gets hot I guess, the thermometer never worked again. It was just one of those cheap flexible ones, but still.

[JJR512]

I can't believe I misspelled "temperature" in the subject line of this thread.:blush:

[MMiz]

I can't believe I misspelled "temperature" in the subject line of this thread.:blush:

I have no clue what you're talking about ;)

[TTLWHKR]

I have no clue what you're talking about ;)


I do. :P

[Phridae]

I have no clue what you're talking about ;)

Nonchalant wink... Yeah, no one noticed. =p

We have the tympanic thermometers in our rigs, but I've never use them. We use the good ol' "yeah, he feels warm"

[SafetyPro]

I actually just saw this same discussion in another board, and it got me thinking. Temperature is not something we normally check, and all we carry to do so are TempaDots, which I happen to think are next to worthless (I've never been able to really read one).

I checked our Basic Scope in the EMS manual and it does say "Obtain diagnostic signs to include, but not limited to the assessment of temperature, blood pressure, pulse and respiration rates, level of consciousness, and pupil status." However, what's interesting is that there is no place to document a temperature on the County EMS form other than in the narrative and the check boxes for "hot" and "cold" under skin signs. Our form is very detailed and includes specific boxes for most everything, so the lack of a specific place for a temp tells me that its not considered "important" by the EMS agency, and I've only been asked once by a nurse at PT transfer if we took a temp.

I think I'm going to ask our CE instructor about it at our next EMS drill and see what his take is.

[Wingnut]

Good idea, let us know what he says.

[TTLWHKR]

TempaDots

They have been known to be sharp and cut the bottom of the tongue.

I prolly have dozens of them in a box some place, for lack of a conventional thermometer, and lack of good batteries in the tympanic in Jenn's bag.. I settled for the use of one last year while I was sick. I was to the point where you stop feeling cold with a fever, and actually begin to feel really hot. Of course, I'm hott anyway. B) lol. Anyhoo. I peeled one off, and it ripped in half. sh*t. so I did another. same deal. Finally, I got one out, I think the others stuck b/c a bottle of H20 leaked in my whacker bag. again. anyhoo. It was sharp, I could barely see the little green dots, it hurt my mouth, and cut the underside of my tongue. In the end, I have no idea what it was, because by the time I looked at it, all the dots were green from sitting under the lamp. <_<

[EMR06]

I would consider temperature important just as anything else.

[TTLWHKR]

Well... Maybe in the hospital. I don't take every patient's temp. That would be a waste of time. I aim for the important times, etc. Suspected or known hypo and hyper -thermia; really sick kids, etc. Usually it's a core temp in the severe cases, but I usually stick with axillary to keep things comfortable for the patient.

[SafetyPro]

I actually just saw this same discussion in another board, and it got me thinking. Temperature is not something we normally check, and all we carry to do so are TempaDots, which I happen to think are next to worthless (I've never been able to really read one).

I checked our Basic Scope in the EMS manual and it does say "Obtain diagnostic signs to include, but not limited to the assessment of temperature, blood pressure, pulse and respiration rates, level of consciousness, and pupil status." However, what's interesting is that there is no place to document a temperature on the County EMS form other than in the narrative and the check boxes for "hot" and "cold" under skin signs. Our form is very detailed and includes specific boxes for most everything, so the lack of a specific place for a temp tells me that its not considered "important" by the EMS agency, and I've only been asked once by a nurse at PT transfer if we took a temp.

I think I'm going to ask our CE instructor about it at our next EMS drill and see what his take is.

Didn't have a chance to ask the instructor (he didn't show up for our drill), but interestingly, our EMS Battalion Chief recently purchased a digital thermometer with probe covers for our trauma box, so we now have a better option than the Temp-a-dots.

[RALS504]

At my last service we got Exergen temporal thermometers in all of our rigs. The main rational for this was that we did alot of critical care transports (especially when there is too much wind and/or snow to get a fixed wing crew in) so we run blood and blood products on weekly basis. We wanted an accurate way to make sure there was no reactions to the blood. The funny thing is now I work for the same healthcare company in the main Adult ICU and ER with standard digital thermometers. We had nicer thermometers on the rigs; it does not make sense to me.

[TTLWHKR]

Temp-a-dots.


They're great, until you get a cut under your tongue. :unsure:

For being something for the delicate tissue under the tongue, they are pretty darn sharp!

[divinewind_007]

we dont have any protocols here for taking temperatures however we do have them on our rigs. if there hot or cold you can tell by touch...so they sit there unused

[Imagine]

Not to mention fevers really aren't bad things...and if they are then that's probably why ther pt is calling for us, they'd most likely call saying...he/she has a 108 degree fever. Even then we keep the pt cool and get them to the ER, there's nothing in our protocols for it either.


I just had to butt in here...Fevers are SEVERE risks in children and infants. Saying they aren't bad things is false. That said, a fever can be detected just by assessing other signs, such as skin temperature and color, we don't really need the exact number in scenarios like that...

A fever could decipher between a high priority and a low priority pediatric patient, and could warrant ALS, where it normally wouldn't be dispatched.

[TTLWHKR]

I just had to butt in here...Fevers are SEVERE risks in children and infants. Saying they aren't bad things is false. That said, a fever can be detected just by assessing other signs, such as skin temperature and color, we don't really need the exact number in scenarios like that...

A fever could decipher between a high priority and a low priority pediatric patient, and could warrant ALS, where it normally wouldn't be dispatched.

It says "Fevers really aren't that bad". It doesn't say all fevers won't hurt you at all, now does it? Fever is the body's natural response to infection. Raising the body temperature helps the body to fight off the infection, so it is not always necessary to treat the fever. Anything from 100.5-101.5 PR, I wouldn't worry about - give some tylenol; 102-102.5 call the doctor and cool them down.. rub them down with luke warm water. While it does make them shiver, which in fact raises the body temperature, it promates evaporation. This cools the body at the same time. 103-103.5 PR go to the ER. 103.6 + Worry. Although, most febrile seizures in children are not harmful, unless there are underlying factors.

For us:
Core Temp (infants/toddlers) Axl (6+) unless unconscious> Vitals >
Seizures: No> IV NS room temp; Yes: Diaz PR per protocol
IV NS room temp
no ice packs unless it is an older child
bottled water poured on a washcloth should be fine

[rocket]

There is nothing in our protocols that requires us to take a temp, but we do have tympanic thermometers on our rigs.

Every patient gets a basic assessment of skin temp/color/condition with the results noted in the appropriate section(s) of the PCR. This is a "hands-on" assessment, not one performed via thermometer or other specialized tools.

That said, I do try to obtain a quick tympanic temp on any patients for which I think the info may be helpful/useful for the ED folks. It doesn't take much time to get the numbers and a phrase like "temp 100 F by tympanic @ 23:58" doesn't steal too much valuable space away from the narrative sections of the PCR.

-Trevor

[fm_emt]

Just grab the rectal thermometer and say "Time for a temperature!"

You'll very quickly weed out the fake-job patients. ;-D

[EMTBSmokeMonkey]

Just grab the rectal thermometer and say "Time for a temperature!"

You'll very quickly weed out the fake-job patients. ;-D


you forgot the most important part "darn, i just ran out of lubricant on that last nasal airway. sorry dude no lube for you..."

that get'll up and at'em.;)

[SwissEMT]

Just grab the rectal thermometer and say "Time for a temperature!"

You'll very quickly weed out the fake-job patients. ;-D

Nothing cures Miranda Disease faster!;)

[BEorP]

In Ontario the PCP provincial directives require a temp before giving nebulized salbutamol (it needs to be less than or equal to 38.0 celcius)

[Jon]

In Ontario the PCP provincial directives require a temp before giving nebulized salbutamol (it needs to be less than or equal to 38.0 celcius)
what is salbutamol, and why is it administered? I've never heard of it.

[disassociative]

Well,

1. Temp is a good indicator of infection.
2. If my pt had a tp of > 103; I would absolutely want to know this
seeing as brain damage could set in.

3. I always go by the old TPRDP Temperature, Pulse/PulseOx, Respirations, Disabilities, Pain Level; put this along with S.A.M.P.L.E. and a good DCAP-BTLS; and boom--you have a good report for the ER.

[RALS504]

Salbutamol is Albuterol or Ventolin for those of us American EMTs.

[Jon]

10-4, K ;)

[sarahharter]

i can understand why we don't generally use temp. i have a normal temp between 95 and 96. when i was taken to the hospital my for febril seizures my temp was only around 99 to 100. but to the emt's that was a normal temp and didn't understand what was going on. i knew the emts and they didn't relize that some people's temps were out of whack! (as they said) we take the temp on my rig but we also try to find out what their avg one is because somehthing may be bad for them but normal for others

[SwissEMT]

Sarah,

Febrile seizures are not really caused by huge increases in body temperature, but rather because of genetic mutations that occur in GABA receptors in the body of some, thus why you were having Febrile Sz with a temperature which might not seem hugely abnormal. Because of this, it causes one temperature to be mildly elevated with no FBz while others will enter seizure.


-V