Should all patients have temp checked rectally?

[spenac]

Because I've found more than a few people who turned out to be hypoglycemic. 1 or 2 hyperglycemic, with no prior history. What's the harm?

No harm just curious. But same logic could be applied to several other procedures including at least one I've been beat up here for suggesting. We do lots of blood glucose level checks on non diabetics as well but not all.

[Dustdevil]

Because I've found more than a few people who turned out to be hypoglycemic. 1 or 2 hyperglycemic, with no prior history. What's the harm?

Two problems I see right off the bat.

First, we don't treat numbers. We treat patients. If somebody is hypoglycaemic, and it has no relavancy to their condition, then you have no business doing anything about it. The chances of it being because of a pancreatic tumour or other such abnormality are pretty slim. The reason their sugar is low is because they haven't eaten all day. It'll fix itself.

Second, if it is something that needs to be followed up on, you just screwed their labs with your amp of D50. You haven't fixed anything. Nothing was broken to begin with. Check your own BGL a few times a day and you'll probably find yourself hypoglycaemic at some point too.

Why don't you go ahead and check everybody for a hernia too? There's just as many of those floating around as there are people with pathologically low blood sugar. How about prostate exams? You could actually save a life with that one. So why not do those too?

[spenac]

Knew we'ld eventually stir you up dust. Maybe I add checking it to my other list this post. More fun for me and less transports.

But really having another vital on the sheet shouldn't hurt. But I agree treat the patient not the monitor applys here. I have some regulars that are almost always low blood glucose on the monitor but no other signs/symptoms. On the flip side I have 1 that if drops below 350 starts getting sick including altered mental status, so definitly more important to treat patient than what the machine tells us, If treated monitor would hit them with insulin then have real problems.

[AnthonyM83]

Check your own BGL a few times a day and you'll probably find yourself hypoglycaemic at some point too.

Why don't you go ahead and check everybody for a hernia too? There's just as many of those floating around as there are people with low blood sugar. How about prostate exams? You could actually save a life with that one. So why not do those too?

Checked mine during my EMT school ride-along...I was in the 30s. Definitely light-headed and tired, but I routinely feel like that when I'm on the go and have never gotten low enough to have any problems. Non diabetic.

As far as doing something to every patient, there's no real harm to that patient, but it's embracing the idea that we do things just because. It's an outlook type of thing. The way your approach medicine.

[katbemeEMT-B]

We check BGL quite often on our patients. Of course we also ask them when they ate or drank last and what they had so we can gauge how it is affecting the results. I don't know that I would say check every patient though. There is a doctor at the Mayo Clinic and Hospital who is pushing to have this added as a regular vital for all pre-hospital and ED care. His reasoning is that, put more simply because I don't remember the exact physiological explanation, is that the body uses the proteins and sugars from the insulin to assist it's natural healing. What he failed to explain to us is how we as pre-hospital care givers can treat a patient is their BGL falls outside the normal parameters.

So again, I would say it's probably a case by case although I do think many patients, especially the elderly, do get there BGL checked pre-hospital.

[HellsBells]

First of all WTF? Why should we put Pts. through the indignity of jamming a probe up their ass unless its absolutly nessesary? Seriuosly, on what % of Pts. will the Tx plan be changed because of the accuracy of a good old anal temp? Even if a Pt. is Septic, or has Pneumonia there are other clinical signs/ symptoms, and tympanic temp, will indeed show an elevated/ lowered temp (of course not as good as a core temp). Granted, they could be useful with infants, and hypothermic pts. But, overall? Not a nessesary pre-hospital tool, in my opinion.

As for BGL's, don't know what you guys use out there, but after starting an IV I can use a pen to push a drop of blood out the needle onto a test strip and get a sample that way, then we dont have to poke them twice. So, most of the pts we start IV's on get BGL's.

[Dustdevil]

As for BGL's, don't know what you guys use out there, but after starting an IV I can use a pen to push a drop of blood out the needle onto a test strip and get a sample that way, then we dont have to poke them twice.

1. Is that a rollerball pen, or just a regular ball point? Does it matter what colour ink we use? :?

2. Do you know the differences between capillary BGLs and venous?

Not a nessesary pre-hospital tool, in my opinion.

By that same logic, you could pretty well say that just about every bit of info an EMT elicits in their exam is unnecessary. So now we're back to just being ambulance drivers. Wonderful. :roll:

[HellsBells]

Well Dust, you know, I prefer Black, ballpoint pens, but thats just me.

As for the difference between capillary and venous samples, good question, one that I never really though much about. According to a couple studies on the topic, there seems to a slightly higher BGL rate with venous samples between the two in healthy Pt's, but what is interesting is that in cases of hypotension capillary samples are actually quite inaccurate and venous samples seem to be more in line with lab values. I'd like to hear what you have to think about the topic, dust.

http://www.bestbets.org/cgi-bin/bets.pl?record=01090

http://emj.bmj.com/cgi/content/abstract/22/3/177

On the other topic, I fail to see how not taking rectal temps makes the rest of the assessment unnecessary and makes me out be be some sort of shabby, lazy Ambulance driver wannabee. Sure, its a good tool to have, but I'll repeat, unnecessary in the majority of ambulance transports. You can still recognize and treat febrile pts without it. Furthermore we don't carry them on car, so its not even an option here; unless we bring them in from...home.

[Dustdevil]

Well Dust, you know, I prefer Black, ballpoint pens, but thats just me.

LOL, well actually I asked that because I have no idea what you are talking about. Never used a pen for anything more than writing down the results of my BGL, not for taking it. Can you elaborate on this process you are talking about?

On the other topic, I fail to see how not taking rectal temps makes the rest of the assessment unnecessary and makes me out be be some sort of shabby, lazy Ambulance driver wannabee.

Damn, I seem to be getting worse at making my points clearly around here lately. I think I'm getting old timers disease. :?

Anyhow, I wasn't taking a shot at your personal practice. I was merely drawing a parallel between taking BGLs and and performing all of the other portions of a physical exam that give us results we can do nothing about. Do you check your patient for his alertness and level of orientation? Why? You can't do anything about it. Battles Sign or Coons eyes? Can't do anything about it. Fluid in the ears? Can't do anything about it. Abdominal tenderness, masses, or pulsations? Why? Again, you can't do anything about it?

If you're going to throw out physical exams because we can't do anything about the findings, that is one thing. But if you are just going to pick and choose them randomly, then that doesn't make any sense at all. If all we do is drive people to the hospital, then yes, we are just ambulance drivers. But if we render medical evaluation and care, we are medical providers. And if we are going to be medical providers, we need to be the best we can be, not just perform to a level that is convenient for us.

Furthermore we don't carry them on car, so its not even an option here; unless we bring them in from...home.

Okay, no personal shots at you, but yeah... your service sucks.

[scratrat]

Temperature topic...no.

Occassionally I've been curious to know what it might be. We used to get nasty GHB overdoses in AC all the time, and when the ambient temperature outside is 20 degrees, and they are pouring with sweat, I'd be curious to know what their temperature is. I've never checked because it won't alter my course of treatment. I've had the ER tell me numbers like 106 or 107 degrees with GHB, thought that was neat to know, but I'd never take the time to check it in the field being that close to definitive care. (Don't start tearing into to me about "definitive" Dusty.. ) I've used it once on a pediatric febrile seizure, but thats about it.

On the pen topic, we did the same thing up north. We used the Jelco needles for IV access. I forget the name of them, but I know when you thread te catheter off of the needle, it locks into position. You can use a ballpoint pen on the opposite end to push a small amount of blood back out of the needle to get a reading. The needle never came back out to my knowledge, but yes Dust, the possibilty of stuck exists.

On the glucose topic, I do it depending on complaint. I had a guy with an acute MI who just kept stating he felt tired and weak and required a lot of intervention to keep awake. Yes, I understand that the MI probably caused most of that. But I checked his sugar anyway, and found it to be 35 mg/dL. Am I not supposed to fix that? I want your opinion of this Dust. Because I did correct it, or in your previous post, I guess made it worse?? But if his sugar is low, and I don't correct it, isn't that going to be worse on the heart? Wouldn't that cause more problems? I understand that the dextrose wears off quickly and he needs to eat, but most likely he would have been NPO for cardiac cath. So, weigh in. And as a side note, for all cardiacs here FL, my employer requires a blood glucose on all these pts.