Checking temp 'to touch.' What part of your hand do you use?

[DwayneEMTP]

So I'm watching some show last night and notice that the nurse, like always, checks the pts temp to touch with the back of her hand.

I've seen this done, have been told that it is the correct way to do it, but why?

My fingers have almost half of a century of experience checking the temp of things, the back of my hand almost none.

I wonder if it's a holdover from checking the tempt of baby bottle fluids? But then one's not really looking for a true temperature but only comfort/discomfort.

I'm a pretty good judge of a patients temp as far as too low, somewhat low, relatively normal, somewhat high, burning up, with my fingers, but the back of my hand is terminally dysfunctional for this purpose.

What do you do? (Yeah, I know, everyone but me has a thermometer, and only wankers would ever use their hands...) and why?

Dwayne

[Cookie]

I use the back of my hand or the inside of my wrist. Because of age, occupation other than Emt, my fingers are not as sensative to hot or cold as others are. Way back when the babies were born I was told to check their bottles on the inside of my wrist and the bath water either back of the hand or inside of the wrist, these places are the most sensative to temp variations by the nurses and others. Just saying this is what I do.

[nypamedic43]

I use the inside of my wrist. My hands are always cold in the winter (means a warm heart ) so a febrile patient feels even more so if I use my fingers. The back of my hand works well too but I prefer the inside of the wrist.

[akflightmedic]

Yep I agree...I have been using my forearm/wrist for years...it is more sensitive. They taught this to me way back on the early 90s....LOL

Then it was reinforced when I had kids. Arguably, I can hold my hand against something hot or cold way longer than I could my forearm.

[DFIB]

I think that we check the temperature by pulling our glove down and using the back of out hand because that is what the AAOS EMERGENCY Care and Transportation of the Sick and Injured Tenth Edition states as part of the Primary Patient Assessment. If it is still in the Tenth edition I could be reasonably sure that it had been included in the prior editions as well.

The text reads:

”Body temperature is usually measured with a thermometer in a hospital. However, in the field, feeling the patient’s forehead with the back of your hand is usually adequate to determine whether the patient’s temperature is elevated or decreased”

AAOS EMERGENCY Care and Transportation of the Sick and Injured Tenth Edition states in Chapter 8, page 273

[scubanurse]

I agree with most... I use the back of my wrist. I think Dwayne's point could be valid but I think of it this way--Yes my fingers have years and years of experience touching hot and cold things and determining temperature, but because of that I feel like they are desensitized to the variations. Especially here in CO my fingers and hands are always cold but my wrists stay warmer...

[DFIB]

I agree with most... I use the back of my wrist. I think Dwayne's point could be valid but I think of it this way--Yes my fingers have years and years of experience touching hot and cold things and determining temperature, but because of that I feel like they are desensitized to the variations. Especially here in CO my fingers and hands are always cold but my wrists stay warmer...

I have calluses on my hands as well as many other active people. This could cause desensitation as well.

[tcripp]

Dwayne, where do you come up with this crap? Just kidding...this is a great question.

I've been using the back of my hand, wrist or inner forearm for years to assess temperature, whether it was for a body temp of my child or a patient or bath water or testing the heat of formula. I recognize that this is only a relative temp and I understand that I don't use my lips or fingers because they can more quickly change with the ambient temperature. (Apparently, using one's lips to check your pt's temp is frowned upon. Who knew?)

In doing a little research (online), I did find a site that read you should check the temp of your own forehead first, then compare that to your patient. Apparently "everyone does it" but I have yet to find anything that reads "why".

[chbare]

Solid question Dwayne!

[tniuqs]

Yep I agree...I have been using my forearm/wrist for years...it is more sensitive. They taught this to me way back on the early 90s....LOL

Could this be another EMS myth ? I say YES it is.

In fact is the hand has far more temperature receptors than any other part of the human body although AK is the confirmed expert in goats (well, so I have been told)

Then it was reinforced when I had kids. Arguably, I can hold my hand against something hot or cold way longer than I could my forearm.

Ok I have to ask what were you holding ?

The palmar surface of the hand also has a higher tolerance to temperature extremes .. AK you worked in the Arctic, you know that the hand with first nations folks can tolerate even colder temps and far far longer, it is a genetic tolerance developed over centuries.

This type of evaluation of temperature is all folly (not that I don't touch my patients as an indicator but moisture level is of key clinical revalance ) when a patient presents beet red and one can fry eggs on a forehead its time to get a bit more invasive.

In a primary delivery of health care education day with a present employer this topic was discussed even more depth the tympanic type thermometers can be up to + or - 4 C .. the only reliable ways of determining core temp is 10 cm probe up the chute and even oral can be affected by ambient temperatures although a less challenging method with the adult evaluation for bacterial vs viral URTI of which I see 3 to 4 patients a day.

Oh the why didn't you get the Fluviral that the clinic was offering for free and then the subsequent lecture and finger waving.

PS I would really like to bitch slap that Jenny McCarthy myself.

I have personally purchased a Infrared Probe (ps not cheap) Have bench tested the oral "mercury" tip of the thermometer (yes that's what the purchaser went to <sheesh> ) My personal evaluation is in comparison to the tip of the mercury immediately after the 3 minutes (oral) and the Infrared focused on peritonsillar area is dang close + or - . 3 C as not a lot of "takers" in the oilpatch are willing to comply with request of rectal temp probe, but your mileage may differ.

My study was a matter of do I transport a rig pig or observe for 24 hours ? This makes a big difference in where I practice.

http://www.cps.ca/english/statements/cp/cp00-01.htm

http://welchallyn.dk/documents/Thermometry/Ear%20Thermometry/Temp_Measure_in_Crit_Ill_Adults_OLC.pdf

http://ajcc.aacnjournals.org/content/9/4/254.abstract