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

[9OrangeLetters]

I use the part of my hand that's holding a thermometer. A tympanic probe might be +/- 5°C but that's far more accurate than "I think it feels hot".

Maybe a good idea to get a general tenor of the patient's temperature by using the back of your hand, inside of your wrist or your fingers/palm, but I wouldn't go basing any patient treatments off of voodoo, no matter how you do that voodoo so well.

There's a whole lot more of the clinical picture that we're leaving out here. I would expect hyperthermia to have associated reflex tachycardia, flushing, altered mental status, etc. I would also expect that hyperthermia that is the result of an infection to have my patient present with a "toxic" apperance, shivering at room temperature, general malaise, etc. With hypothermic patients, I would expect them to present with peripheral cyanosis, bradycardia, also altered, perhaps if they were septic a more noticable "toxic" apperance than relative hypothermia...

There's more to this than "what part of your body are you using to check your patient's temperature"... I think if you're relying on subjective data for patient treatment or assessment, it's bad medicine.

[HERBIE1]

I use the part of my hand that's holding a thermometer. A tympanic probe might be +/- 5°C but that's far more accurate than "I think it feels hot".

Maybe a good idea to get a general tenor of the patient's temperature by using the back of your hand, inside of your wrist or your fingers/palm, but I wouldn't go basing any patient treatments off of voodoo, no matter how you do that voodoo so well.

There's a whole lot more of the clinical picture that we're leaving out here. I would expect hyperthermia to have associated reflex tachycardia, flushing, altered mental status, etc. I would also expect that hyperthermia that is the result of an infection to have my patient present with a "toxic" apperance, shivering at room temperature, general malaise, etc. With hypothermic patients, I would expect them to present with peripheral cyanosis, bradycardia, also altered, perhaps if they were septic a more noticable "toxic" apperance than relative hypothermia...

There's more to this than "what part of your body are you using to check your patient's temperature"... I think if you're relying on subjective data for patient treatment or assessment, it's bad medicine.

I realize you are brand new here, but let me make a suggestion: maybe you're first post shouldn't be filled with such arrogance. (If this was not your intention, then I apologize)

Of COURSE feeling with the back of your hand or your wrist isn't the most accurate way to check a patient's temperature. That's like saying feeling for a radial pulse is not the most accurate way of obtaining a blood pressure. I think the point of this is for folks who do not use thermometers prehospitally to come up with best way to determine if a patient may be febrile WITHOUT the use of a thermometer. We don't use them in our system, nor do many folks, so I think these tips are a good idea. An elevated temp can indicate a million things, but unless you have some lab values to go with that specific number, it's essentially meaningless-especially since most EMS field providers won't be prescribing antibiotics or even giving an antipyretic.

[tniuqs]

HERBIE1 ... sorry mate

I don't see arrogance at all but I do see some humour in in his post, 9orange is making a good point .. perhaps we all should be using a real thermometer(s) it is a vital sign.

<cough> There are those that do use antibiotics AND antipyretics IV as well as inducing hypothermia OR treating it in the field.

ps Don't set your sights so LOW ...... Please.

It is essential when treating hypothermia to have a rectal probe up the chute as "cold and waxy" to the touch on a patch to an MD 600 kms away on a sat phone just doest cut the mustard.

cheers

Edited December 25, 2011 by tniuqs

[HERBIE1]

HERBIE1 ... sorry mate

I don't see arrogance at all but I do see some humour in in his post, 9orange is making a good point .. perhaps we all should be using a real thermometer(s) it is a vital sign.

<cough> There are those that do use antibiotics AND antipyretics IV as well as inducing hypothermia OR treating it in the field.

ps Don't set your sights so LOW ...... Please.

It is essential when treating hypothermia to have a rectal probe up the chute as "cold and waxy" to the touch on a patch to an MD 600 kms away on a sat phone just doest cut the mustard.

cheers

Allow me to direct your attention to this passage:

"I think the point of this is for folks who do not use thermometers prehospitally to come up with best way to determine if a patient may be febrile WITHOUT the use of a thermometer. We don't use them in our system, nor do many folks, so I think these tips are a good idea."

Notice the MAY and MANY qualifiers. I know how varied our job responsibilities are here, and some folks here are a few classes- and a few dollars short- of being MD's.

Like I said, if this was undetected sarcasm, then I apologize, That was not the way I read it, but it certainly would not be the first time I was wrong.

[tniuqs]

Your a good man Herbie1

[DFIB]

.

Like I said, if this was undetected sarcasm, then I apologize, That was not the way I read it, but it certainly would not be the first time I was wrong.

I don't know if 9Orange's intent was to be arrogant but I am pretty sure it was a disparaging remark against the other posters that do use alternative non technological measures to measure temperature. To speak of something as simple as checking skin temperature that is recommended in the AAOS literature, as voodoo medicine shows a disdain for providers that use that method. He is almost implying that they run around killing chickens and breaking eggs on people’s heads to heal their illness that are other voodoo practices.

It may not have been arrogant but surely indicates certain haughtiness.

Edited December 25, 2011 by DFIB

[tniuqs]

I don't know if 9Orange's intent was to be arrogant but I am pretty sure it was a disparaging remark against the other posters that do use alternative non technological measures to measure temperature.

Ok so just what EMS service can't cough up some means of taking a temp .. like really ?

AND Not to say touching your patient does not afford good bedside observation.

To speak of something as simple as checking skin temperature that is recommended in the AAOS literature,

Ahem did you read the links .. this thread was Dwyane making a teaching point that morphed and back to trusting your equipment, 12 Leads, Pulse Ox, NIBP, ETCO2 or last but not least the BGL thinghy, need I get into determing BP by pulse strength ... meh.

So:

Is the patient dang chilly, slimy or soggy ?

Is the patient going to start to do the funky chicken right quick ?

Point made, but my palmar surface of hand hasn't misled me too much, might I suggest some good handmoisturizer Dwayne ? ( egg nog and rhum does that to me)

as voodoo medicine shows a disdain for providers that use that method. He is almost implying that they run around killing chickens and breaking eggs on people’s heads to heal their illness that are other voodoo practices.

Crap ... frying eggs on a forehead is WRONG ... rats.

It may not have been arrogant but surely indicates certain haughtiness.

Pfft .. perhaps his way of being taken seriously ?

cheers

[DwayneEMTP]

...

I use the part of my hand that's holding a thermometer. A tympanic probe might be +/- 5°C but that's far more accurate than "I think it feels hot".

Maybe a good idea to get a general tenor of the patient's temperature by using the back of your hand, inside of your wrist or your fingers/palm, but I wouldn't go basing any patient treatments off of voodoo, no matter how you do that voodoo so well...

Exactly why the question was regarding whether or not those methods were based in logic or just urban legend passed down from grandmothers.

...There's a whole lot more of the clinical picture that we're leaving out here. I would expect hyperthermia to have associated reflex tachycardia, flushing, altered mental status, etc. I would also expect that hyperthermia that is the result of an infection to have my patient present with a "toxic" apperance, shivering at room temperature, general malaise, etc...

You would expect all of that in a pt that's 99.5F? As they are hyperthermic, right? Are you not interested in localized hyper/hypothermia then? How does your tympanic thermometer work when assessing cellulitis without global hyperthermia? My guess would be not very well. How about the soldier with numb toes who's CO needs to know if it's ok for him to continue in the field or needs to be removed? Is it then still voodoo to assess temp to touch?

I would expect some, or all of these symptoms as well, and if fortunate to have a reliable history would feel very comfortable treating them based on touch, and I do often deal with antibiotics, though would rather have a finite number to record in his/her records. When in the clinic I always have a reliable thermometer, in the field almost never.

...There's more to this than "what part of your body are you using to check your patient's temperature"... I think if you're relying on subjective data for patient treatment or assessment, it's bad medicine.

Fair enough. Let's say that you have the above hyperthermic patient, what treatment alterations are you going to make based on a digital number on your thermometer? Will you choose not to actively cool this patient if the thermometer reads 99F? Would you choose to run emergent to the ER if your thermometer reads 106F yet your patient is cool to touch globally?

How about if you have the exact patient above...what will be your different treatment plans be if your thermometer says 99F, 101F, 103F? How will you treat each of those patients differently?

I absolutely got the tongue in cheek tone of your post, and thought it was very well written, expressing your opinion very well...Your opinion is just very narrow minded.

Thanks for participating.

Dwayne

[Chief1C]

That's a good ID... 9 Orange Letters... I get it.

Anyhoo.. I use the top of my forearm, just nearest my wrist. That seems to be the most sensitive portion of my arm. On thermometers. I believe it was '08.. We had just switched to a temporal scanner, from digital probe types, for safety. Ordered them on a Thursday, arrived on a Friday, just after we returned from a bad call. The kind where all you want to do is curl up in a ball and cry. Move to Monday, hanging out in the station, still totally bumming about the call, everyone is grumpy, not really talking, looking like death under a banana tree.

Decide to break the ice by unpacking the box of stuff from Moore. Put various shit away, opened the new temporal scanner, put the batteries in it. See how it works.. That can't be right. Feel for a pulse in the temple, use it again. No, what a POS. Other guy tries it. Ambulance capt. steps in, tries it. Normal. Tries it on the other guy again. 104 point something. Our patient that died, a child, had a rare, deadly secret that was passed on to the rescuers, five in all. Had to take antibiotics for two months. But I really like the temporal scanner thermometers, they're almost perfectly accurate if you use them over the ear, instead of the temple.

[tniuqs]

Ok great points but your missing the question posed .. Dwayne do you use hand moisturiser ?

Damn that heathen pirate grog called egg nog <ahem> and somewhat fortified, I would love to retort but this pirate training is making me eyes blurry ..... and 2c4 "the gear head" and "vampire killer" of all time ... link to temporal scanner svp.

cheers