Should all patients have temp checked rectally?

[speedygodzilla]

("Ridryder 911

Let me know what hospital you work at & I will avoid it. Never seen a patient with a fever? Tympanic (not temporal) temps are considered inaccurate and worthless @ especially in those that are febrile.

[u)

All patients with possible sepsis, hyper/hypothermia should have baseline rectal core temps. They are called core temps for a reason.

I suggest your ER and clinical manager do some investigation on core temps and policies. Emergency Nurses Association as well ACEP has some recommendations. There is some great literature and studies out there.

R/r 911

I am not saying the hospital doesn't check them on possible sepsis, or hyper/hypothermia. I just have never seen it done. I done believe I have ever dealt with these patients. I see many patients but do not see all that the ER does. I will be sure to ask some on the RNs if they do check the rectal temp on these patients next time I am at work.

By no means are we going to do them on all patients. That is unnecessary for us in the ER and even more so in the field.

[Just Plain Ruff]

I worked in a ER for 4 years one stint and then again for 3 years again about 4 years later.

I took care of hundreds if not thousands of patients and only the unconscious ones that we could not get a oral or tympanic temperature we took it rectally.

All peds from 8 and under got rectals and if the tympanic temp piece of crap gave a wierd reading, ie one that did not jibe with their skin temp versus the reading even adults got a oral or a rectal.

Usually we were able to get oral temps on all adults except the notable few.

I think rectal temps in the ambulance except peds do not warrant a rectal temp. It's no fun by the way trying to find the hole in a uncooperative child let alone a adult.

If any patient is hypothermic or hyperthermic(markedly so I mean) they got rectal temps no matter how old they were.

I have to argue the fact on the poster who said every patient got a blood glucose level checked. I don't think that is good medicine but you relayed that your protocols are your's and mine are mine so I'll leave it at that.

it's sort of like the career day or the demo at a local day care. we used to put kids on the cardiac monitor until we spotted a abnormality on a 5 year old little girl. She had short runs of svt. Parents were pissed that we put a medical device on their child without their permission. We ended up having to transport this little girl to the ER due to this problem we found. Parents refused to pay the bill until the cardiologist advised her that this could have been a fatal event if left untreated and unchecked. Parents still were unhappy. The service that I was at at the time put a policy out after that saying we could not put cardiac monitors on children with out their parents permission.

[speedygodzilla]

Let me know what hospital you work at & I will avoid it. Never seen a patient with a fever? Tympanic (not temporal) temps are considered inaccurate and worthless, especially in those that are febrile.

All patients with possible sepsis, hyper/hypothermia should have baseline rectal core temps. They are called core temps for a reason.

I suggest your ER and clinical manager do some investigation on core temps and policies. Emergency Nurses Association as well ACEP has some recommendations. There is some great literature and studies out there.

After talking to a few of the RNs here it seems to be a case by case thing for patients. They all seem to agree that hypothermia for sure would get a core temp, but seems to be have be taken case by case for the others. They don't seem to just have a cook book that says all patients with such and such get this. They are allow to think for themselves and mainly follow the doctors orders.

[AnthonyM83]

Man... the suck-arse state of some systems is just mind boggling. And the scary part is that their medics don't even realise it. :?

Dust, I think you (and others here) would get along great with the instructors at the paramedic school where I'm taking my 'paramedic prep' class right now. Unfortunately, I won't be able to afford actually going there...but least I'm getting a good basis/outlook on paramedicine from them...usually don't see that in the field around here...have to come to the message boards for it.

[HellsBells]

spenac said

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.

I'm kind of unearthing this post from the dead, but as we regularly check our BGL's from IV sticks, I thought I'd actually read the manufacturers directions to see what they say.

Our test strips are called Ascensia Elite. Here is what they have to say on collecting samples.

"Sufficient blood to perform the test may be obtained from the fingertip... If desired a venous whole blood sample may be used. A venous whole blood sample usually reads higher than a capillary sample (approx 7% higher on average)."

So it would seem you're covered for taking a venous sample by the manufacturer, but ultimately, the finger stick is the most accurate route.

[Eydawn]

Has anyone seen the thermometers that someone places against your forehead and rolls from side to side? The last couple times I've been to see a doc for whatever reason, that's how my temperature was taken. Is that one of the ones that takes a reading from the temporal artery? It looks darn useful on squeaky kids and wigglers and the like... but how does it work?

Wendy

CO EMT-B

[spenac]

Wendy during clinicals the ER used them for triage temp check. They are great as you mention when dealing with screaming healthy kid.

[Dustdevil]

http://www.ncbi.nlm.nih.gov/pubmed/14618168

• BACKGROUND: Thermometry at other body sites than the rectum may have its advantages. Some studies have shown that infrared tympanic measurement has poor sensitivity in febrile patients. We evaluated a new infrared temporal thermometer that calculates core temperature by measuring skin temperature and ambient temperature over the superficial temporal artery.

MATERIAL AND METHODS: During two periods in 2002, 164 consecutive intensive care patients were measured by both digital rectal and infrared temporal thermometry.

RESULTS: The average difference between rectal and temporal measurements was 0.3 degrees C. Fever was defined as a rectal temperature of 38 degrees C and was present in 70 patients. The temporal scanner detected fever in 33 of those patients, which gives a sensitivity of 53 % (95% CI 41-65%) and a specificity of 96 % (95% CI 90-99%). The positive predictive value was 90% (95% CI 77-97%) and the negative predictive value 73% (95% CI 64-81%).

INTERPRETATION: The results are better than for infrared tympanometry. The sensitivity of the infrared temporal thermometer for detecting rectally measured fever is too low to recommend its use in adult intensive care patients.