Should all patients have temp checked rectally?

[scratrat]

And also, I prefer the blue ballpoint pen. Up there, we still had paper reports, so it showed up better on a black background......in case I missed an all too famous checkbox

[katbemeEMT-B]

The ALS service that I work for does the same thing to check BGL. We check every patient who receives an IV. Of course we also check those that are exhibiting diabetic symptoms. It's almost becoming a standard up here. There are actually very few patients that don't get a BGL. The hospitals like the fact that we are checking them because it gives them some thing to compare to, a baseline you could say. Just like the rest of the vitals we check. Do we get chastised for not taking one? Not usually, but there have been those rare ocassions. Depends on the doc I guess.

Oh yeah, I prefer black ball point pen myself.

[Ridryder 911]

I wonder if your boss appreciates paying for the glucose strips on all those patients? They are not cheap and if you passing the costs onto the patient shame on you! That would be like placing an ECG on an isolated neck pain. Personally, I treat the patient as an individual. If they present symptoms as such as altered LOC, DKA, or have a history of DM then yes I will perform a FSBS. Personally, I prefer capillary stick since venous from IV caths have been found to be inaccurate (according to Nat'l Scientific Laboratories) to use in glucometers and why so many ER's use capillary samples.

R/r 911

[spenac]

I wonder if your boss appreciates paying for the glucose strips on all those patients? They are not cheap and if you passing the costs onto the patient shame on you! That would be like placing an ECG on an isolated neck pain. Personally, I treat the patient as an individual. If they present symptoms as such as altered LOC, DKA, or have a history of DM then yes I will perform a FSBS. Personally, I prefer capillary stick since venous from IV caths have been found to be inaccurate (according to Nat'l Scientific Laboratories) to use in glucometers and why so many ER's use capillary samples.

R/r 911

Right on ol chap. Also have you read the manual for your glucose meter. Most clearly state for capillary not for venous. Be careful about bragging about an unapproved test with your equipment, could come to play when your in court for something else to show how little you know, your discredited, you lose, hope you have insurance.

[katbemeEMT-B]

I wonder if your boss appreciates paying for the glucose strips on all those patients? They are not cheap and if you passing the costs onto the patient shame on you! That would be like placing an ECG on an isolated neck pain. Personally, I treat the patient as an individual. If they present symptoms as such as altered LOC, DKA, or have a history of DM then yes I will perform a FSBS. Personally, I prefer capillary stick since venous from IV caths have been found to be inaccurate (according to Nat'l Scientific Laboratories) to use in glucometers and why so many ER's use capillary samples.

R/r 911

The ALS service is hospital based and owned and this is their request. They determine our protocols. That doesn't mean we still don't assess our patients and treat them accordingly. By the way, if we have been called out for or suspect a diabetic reaction we immediately perform a cap. stick. That is done on scene before the patient is ever loaded into the rig. We normally don't start an IV until after the patient is secured in the rig and a full assessment has been done. As stated before, the BGL taken from an IV needle is soley for comparison in the ED. It is not used for us to treat the patient.

Let's also remember that things are done differently in different parts of the country. My protocols are not necessarily yours. I find this just between the two services that I work for. That maybe isn't the best as this does cause confusion when moving from one area to another but that is one of the drawbacks of EMS. Until EMS has a governing body that sets national protocols we are at the mercy of our local MD and what they want. Don't beat me up for what our local ED docs want. As far as the cost, all of our supplies come from central supply at the hospital. To my knowledge we do not bill for BGL testing. When the patient is admitted to the ED and they run a battery of blood work on the patient they include BGL and that is the only time I know of that they are charged for it.

[spenac]

As stated before, the BGL taken from an IV needle is soley for comparison in the ED. It is not used for us to treat the patient.

Let's also remember that things are done differently in different parts of the country. My protocols are not necessarily yours.

This has nothing to do with comparison or protocol, this has to do with are you doing it right. If your protocols require BGL do it but do it right. Check the manuel that came with your meter. Many say only for capillary, doing it any other way than right can call into question all treatments you do in the ambulance. CYA. Not trying to start fight.

OR AM I? :twisted:

[CBEMT]

If I have lancets, I'll do it capillary. If I'm out, I may take it from the IV.

Or if the last shift left me without any and the manager who's office the strips are locked up in isn't in (nights/weekends/holidays/early in the morning), I get to explain to the triage nurse that I have no freaking idea what the patient's BGL is.

[katbemeEMT-B]

This has nothing to do with comparison or protocol, this has to do with are you doing it right. If your protocols require BGL do it but do it right. Check the manuel that came with your meter. Many say only for capillary, doing it any other way than right can call into question all treatments you do in the ambulance. CYA. Not trying to start fight.

OR AM I? :twisted:

The demon is back....ruuuuunnn! LOL

I understand what you are saying and I can honestly say that our levels have been equivalent to those taken in the ED (with the exception of the diabetic we treated and the level increased enroute but that would have been a cap. stick). When we do a BGL from an IV needle it is used for nothing more than comparative value of the ED staff. They are able to disregard it if they want. Out of the five docs that staff the ED, four of them want us to take a BGL from the IV stick even though we wouldn't have deemed it a necessary procedure. Like I said, we assess and treat the patient accordingly. If it happens that we started an IV, the ED gets their BGL. I think the big picture here is assessing your patient and looking for s/s that would be affected by an altered glucose level. When we see those we wouldn't depend on an IV stick we would do a cap. stick. If we also started an IV in the rig we would maybe use the IV BGL for comparison.

[FireMedic65]

I do not see a real big reason to do a rectal temp on a patient in the pre-hospital setting. Maybe on a neonate or something. But lets say for instance, you are 90 miles from a hospital, someone falls into a lake in the middle of winter... rescue gets them out, yadda yadda yadda.... a helicopter cant fly because A Christmas Story marathon is on... so you are on your own. Well... ya need to warm them up... I don't really care what their temp is.... just warm them up properly. If allowed, dual IV warm saline, throw in a foley flush around some warm saline there, etc etc. I can't really thing of any situation where you would have to use a rectal therometer. Their jaw is clamped down... trauama to the ears... who cares about a temp? Like others had said, your treatment won't change if you have their temp or not really. A temp will give you a better idea of what is going on, but you can't do the proper tests to pinpoint what is exactly going on. Yet still, treatment won't change!

[flight-lp]

I do not see a real big reason to do a rectal temp on a patient in the pre-hospital setting. Maybe on a neonate or something. But lets say for instance, you are 90 miles from a hospital, someone falls into a lake in the middle of winter... rescue gets them out, yadda yadda yadda.... a helicopter cant fly because A Christmas Story marathon is on... so you are on your own. Well... ya need to warm them up... I don't really care what their temp is.... just warm them up properly. If allowed, dual IV warm saline, throw in a foley flush around some warm saline there, etc etc. I can't really thing of any situation where you would have to use a rectal therometer. Their jaw is clamped down... trauama to the ears... who cares about a temp? Like others had said, your treatment won't change if you have their temp or not really. A temp will give you a better idea of what is going on, but you can't do the proper tests to pinpoint what is exactly going on. Yet still, treatment won't change!

You really should care and you cannot properly actively rewarm a patient properly without a constant core measurement. If you are going to go as invasive as internal cavity lavage, then you ABSOLUTELY need a thermometer probe up their rear. Without it, how are you going to monitor for after warming drop, or worse hyperthermia? How will you (other than the obvious symptom of death) identify and stay ahead of such complications as rewarming shock? No we do not need to shove a thermometer up every pts. ass we come into contact with, but some do require it, hypothermics especially.....................