Let's not scare off an emergency physician who wants to spend his time contributing to an EMS forum. We need more physicians actively engaged in EMS.
Does anyone carry a thermometer on their bus?
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Let's not scare off an emergency physician who wants to spend his time contributing to an EMS forum. We need more physicians actively engaged in EMS.
zmedic
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I'm starting another thread for ultrasound. As to febrile seizure, reducing fever doesn't reduce the rate of febrile seizure.
Odd. Perhaps my understanding is overly simplistic, but I thought the risk of seizure was associated with the rate that the temperature increased? I would have expected the incidence of seizure to decrease with antipyretics.
Do you have a link to a decent review handy?
Smash
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I don't have the references on my iPhone but I recall reading something similar a while back. No-one really knows why febrile seizures happen. At some point during a febrile illness the hypothalamus decides enough is enough and propagates a wave of uncoordinated activity: a seizure.
However this doesn't seem to be related to absolute temperature or change in temperature. Seizures seem to be as likely as whether the fever is waxing or waning. There is a hypothesis that the seizures is related to circulating inflammatory mediators rather than temperature (which is of course related to said temperature) but it doesn't seem anyone really knows.
We don't give anti-pyretics routinely anymore as it doesn't seem to help. We will give Tylenol if the patient is uncomfortable with myalgia for example, but not as a means of reducing temperature in itself, as it doesn't reduce the likelihood of seizures anyway.
I'll try to find some references tomorrow. Also, this does not mean that I would argue against thermometers in the ambulance. We use them routinely in a number of different settings.
If you have them, it'd be appreciated, but I can also look this up myself, so don't worry if you're busy. We used to give tylenol pretty routinely to sick kids, but I've been out of the field for a bit, so things may have changed in my old area as well.
Looks like I found an ok reference here:
I'm feeling a little silly, but I'm learning!
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Arch Pediatr Adolesc Med. 2009 Sep;163(9):799-804.
Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial.
Strengell T, Uhari M, Tarkka R, Uusimaa J, Alen R, Lautala P, Rantala H.
Source
Department of Pediatrics, University of Oulu, Oulu, Finland.
Abstract
OBJECTIVE:
To evaluate the efficacy of different antipyretic agents and their highest recommended doses for preventing febrile seizures.
DESIGN:
Randomized, placebo-controlled, double-blind trial.
SETTING:
Five hospitals, each working as the only pediatric hospital in its region.
PARTICIPANTS:
A total of 231 children who experienced their first febrile seizure between January 1, 1997, and December 31, 2003. The children were observed for 2 years.
INTERVENTIONS:
All febrile episodes during follow-up were treated first with either rectal diclofenac or placebo. After 8 hours, treatment was continued with oral ibuprofen, acetaminophen, or placebo.
MAIN OUTCOME MEASURE:
Recurrence of febrile seizures.
RESULTS:
The children experienced 851 febrile episodes, and 89 of these included a febrile seizure. Febrile seizure recurrences occurred in 54 of the 231 children (23.4%). There were no significant differences between the groups in the main measure of effect, and the effect estimates were similar, as the rate was 23.4% (46 of 197) in those receiving antipyretic agents and 23.5% (8 of 34) in those receiving placebo (difference, 0.2; 95% confidence interval, -12.8 to 17.6; P = .99). Fever was significantly higher during the episodes with seizure than in those without seizure (39.7 degrees C vs 38.9 degrees C; difference, 0.7 degrees C; 95% confidence interval, -0.9 degrees C to -0.6 degrees C; P < .001), and this phenomenon was independent of the medication given.
CONCLUSIONS:
Antipyretic agents are ineffective for the prevention of recurrences of febrile seizures and for the lowering of body temperature in patients with a febrile episode that leads to a recurrent febrile seizure.
Comment in
I'm feeling a little silly, but I'm learning!
========================================================
Arch Pediatr Adolesc Med. 2009 Sep;163(9):799-804.
Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial.
Strengell T, Uhari M, Tarkka R, Uusimaa J, Alen R, Lautala P, Rantala H.
Source
Department of Pediatrics, University of Oulu, Oulu, Finland.
Abstract
OBJECTIVE:
To evaluate the efficacy of different antipyretic agents and their highest recommended doses for preventing febrile seizures.
DESIGN:
Randomized, placebo-controlled, double-blind trial.
SETTING:
Five hospitals, each working as the only pediatric hospital in its region.
PARTICIPANTS:
A total of 231 children who experienced their first febrile seizure between January 1, 1997, and December 31, 2003. The children were observed for 2 years.
INTERVENTIONS:
All febrile episodes during follow-up were treated first with either rectal diclofenac or placebo. After 8 hours, treatment was continued with oral ibuprofen, acetaminophen, or placebo.
MAIN OUTCOME MEASURE:
Recurrence of febrile seizures.
RESULTS:
The children experienced 851 febrile episodes, and 89 of these included a febrile seizure. Febrile seizure recurrences occurred in 54 of the 231 children (23.4%). There were no significant differences between the groups in the main measure of effect, and the effect estimates were similar, as the rate was 23.4% (46 of 197) in those receiving antipyretic agents and 23.5% (8 of 34) in those receiving placebo (difference, 0.2; 95% confidence interval, -12.8 to 17.6; P = .99). Fever was significantly higher during the episodes with seizure than in those without seizure (39.7 degrees C vs 38.9 degrees C; difference, 0.7 degrees C; 95% confidence interval, -0.9 degrees C to -0.6 degrees C; P < .001), and this phenomenon was independent of the medication given.
CONCLUSIONS:
Antipyretic agents are ineffective for the prevention of recurrences of febrile seizures and for the lowering of body temperature in patients with a febrile episode that leads to a recurrent febrile seizure.
Comment in
bushinspector
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In Oklahoma each truck must have one. It is one piece of equipment that is required by the state
Well since personal insults are accepted again...
I'd say I have doubts that you are even an EMT let alone a paramedic...but there really isn't any doubt about that.
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No they're not and knock it off!
medic417
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Hi how have you been? Hope you are having a great day.
MedicBrew
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Esophageal probe, WOW!!
Are you currently using it for induced hypothermia, uncooperative patients...?
the_negro_puppy
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What about comfort?
When I have a fever I like to take anti-pyretics
Get a temp, then give tylenol if indicated/ patients wants it
Anyone who says "you dont need thermometers" on Ambulances needs to have their head checked. It is another valuable tool of assessment.
When I have a fever I like to take anti-pyretics
Get a temp, then give tylenol if indicated/ patients wants it
Anyone who says "you dont need thermometers" on Ambulances needs to have their head checked. It is another valuable tool of assessment.
Induced hypothermia and intubated patients.
Hellsbells
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Personally, before this topic, I'd have thought there was little cause for controversy over the use of Thermometers in ambulances. To me they are almost akin to other vital signs. I'll agree with Zmedic to the point that they don't typically change our Tx profoundly. However, a temp also helps to form an overall clinical picture of our pt.
I think it is a huge leap to call for the nessesity of evidence or studies to back up the usefulness of obtaining temps prehospitally. Sure, we could provide studies it is benefical in a sepsis protocol, but then what? Only take temps for pts with suspected sepsis because there is no evidence its effective in the Tx of other conditions?
Would there be cost to providing all ambulances with thermometers? Sure there would, but Zmedic, you intentionally miscalculate the cost by counting every ambulance in the country. Perhaps people who work for services in the US already equiped can speak to this, but my guess is that procuring thermometers for their respective services has not been an undue financial hardship. Furthermore, I doubt that even the service area you work in would be pushed to the brink of insolvancy were they to do the same.
I think it is a huge leap to call for the nessesity of evidence or studies to back up the usefulness of obtaining temps prehospitally. Sure, we could provide studies it is benefical in a sepsis protocol, but then what? Only take temps for pts with suspected sepsis because there is no evidence its effective in the Tx of other conditions?
Would there be cost to providing all ambulances with thermometers? Sure there would, but Zmedic, you intentionally miscalculate the cost by counting every ambulance in the country. Perhaps people who work for services in the US already equiped can speak to this, but my guess is that procuring thermometers for their respective services has not been an undue financial hardship. Furthermore, I doubt that even the service area you work in would be pushed to the brink of insolvancy were they to do the same.
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If I could? I would like to ignore all of the subsequent nonsense and just talk about the matter at hand.
Before we get to all of this, if we are arguing about what a particular piece of equipment changes in the field, we should also do the same for the ED.
I would like to point out, that if we took everything off of an ambulance that didn't have research backing its efficacy, the only thing on there would probably be an AED.
As for research, I have pointed out many times, most of the current techniques in EMS and even more than a handful in the ER are based off of 20+ year old expert opinion. Much of it from emergency physicians whos conclusions are highly suspect.
Let us take the analysis of research one further. One or two studies does not and should not change practice guidlines. Especially here people like to demand the citing of sources and cite one or two studies.
How many credible medical practices have 1 or 2 citations?
Because the emphasis of evidence based practice is relatively new in the world of medicine, clinical research on many things, especially in the emergency setting are extremely sparce.
It also doesn't take into account individual experience or intuition, which is just as important to treating patients as quantitative measurement of area under the curve. Especially when the research is mathmatically manipulated to form a bell curve to make a clinical guidline based off of it more palatable.
Do you have a plan to collect usable data on patients who require immediate intervention in the current ethical standards?
While defending the true faith of scientific medicne, please remember that it is generally accepted not to treat patients soley on epidemiology, but by the presentation of the one you actually in front of you.
If 95% of your patients fall under a guidline from validated research, what is the plan for the other 5%? Treat them the same to force them into the guidline and when it doesn't work call it an acceptable loss?
No offense dude, but it doesn't take a doctor to run an algorythm, an NP or PA will work just fine. Why pay more to get the same?
Like what?
What does EMS do that is so complicated or critical that taking a temperature would interfere with it?
A temperature is a vital sign. Is it ok for EMS to have an incomplete set of vital signs when every other provider in every other environment records such?
Why not eliminate BP too?
Let me just preempt this?
There are plenty of physical findings of hypovolemia and inadequete perfusion.
For medication administration, the numbers are rather arbitrary and vary from agency to agency. Even medical specialty to specialty.
If a patient is tachycardic with clinical manifestations of poor perfusion, is it going to change EMS treatment because you assign a number to it?
On the reverse, if you have a 80 year old lady who is not tachycardic with no physical findings of distress is the fact her bp is 80/60 going to prompt treatment?
Of course not.
Why so you can bill them?
People who call an ambulance don't always need a hospital. I stipulate they probably need healthcare. Most certainly don't need an ED (and the associated cost) and would likely be better served at a much reduced rate by a GP or urgent care.
Dr., honestly, how often does a single quantitative finding of anything sway your treatment one way or the other? 1%? 5%?
It is the totality of findings that create a clinical picture, not one. That doesn't change no matter what country you are from, what area of healthcare you practice in, or what level.
I am going to have to disagree and say they should be admitted to an inpatient service in the hospital. Pneumonia in the geriatric population is not going to resolve with the treatment done in the ED. I would even bet in your institution, there is an age criteria for discharging pneumonia patients from the ED.
??? You cannot be serious. If your neighbor asked you to look at their kid (out of hospital) and the kid had normal vitals and a temp of 99, you would suggest going to a hospital instead of an appointment with a pediatrician or an urgent care?
Really?
If that is the case, you are providing no better medical advice than the algorythms from nurse on call. I would be embarassed to say I was no more helpful than such. I would certainly lose considerable credibility among my superiors and peers.
Funny that, I said the same thing everytime I saw patients get a plethora of tests in the ED which take up far more time, resources, and cost in order to protect the doctor and hospital from legal action.
Ask yourself, does that really benefit the patient?
Before you answer that though, recall the burdon of proof and cost effectiveness required to institute routine health screenings for various diseases.
I am not trying to be a jerk (though I may be succeeding) but you cannot possibly demand more of paramedics and at the same time try to tell them what they are already doing doesn't make a difference anyway.
You cannot tell them not to do something that is standard for every other healthcare provider level in the world and not reduce them to more than a glorified taxi. (Even med techs learn to take temperatures)
Please spare me how the ED is going to save all the poor unfortunate souls of the world until they can admit patients to their service or can treat outpatient healthcare issues at the same cost and effectiveness as a PCP.
Before we get to all of this, if we are arguing about what a particular piece of equipment changes in the field, we should also do the same for the ED.
I would like to point out, that if we took everything off of an ambulance that didn't have research backing its efficacy, the only thing on there would probably be an AED.
As for research, I have pointed out many times, most of the current techniques in EMS and even more than a handful in the ER are based off of 20+ year old expert opinion. Much of it from emergency physicians whos conclusions are highly suspect.
Let us take the analysis of research one further. One or two studies does not and should not change practice guidlines. Especially here people like to demand the citing of sources and cite one or two studies.
How many credible medical practices have 1 or 2 citations?
Because the emphasis of evidence based practice is relatively new in the world of medicine, clinical research on many things, especially in the emergency setting are extremely sparce.
It also doesn't take into account individual experience or intuition, which is just as important to treating patients as quantitative measurement of area under the curve. Especially when the research is mathmatically manipulated to form a bell curve to make a clinical guidline based off of it more palatable.
Do you have a plan to collect usable data on patients who require immediate intervention in the current ethical standards?
While defending the true faith of scientific medicne, please remember that it is generally accepted not to treat patients soley on epidemiology, but by the presentation of the one you actually in front of you.
If 95% of your patients fall under a guidline from validated research, what is the plan for the other 5%? Treat them the same to force them into the guidline and when it doesn't work call it an acceptable loss?
No offense dude, but it doesn't take a doctor to run an algorythm, an NP or PA will work just fine. Why pay more to get the same?
Like what?
What does EMS do that is so complicated or critical that taking a temperature would interfere with it?
A temperature is a vital sign. Is it ok for EMS to have an incomplete set of vital signs when every other provider in every other environment records such?
Why not eliminate BP too?
Let me just preempt this?
There are plenty of physical findings of hypovolemia and inadequete perfusion.
For medication administration, the numbers are rather arbitrary and vary from agency to agency. Even medical specialty to specialty.
If a patient is tachycardic with clinical manifestations of poor perfusion, is it going to change EMS treatment because you assign a number to it?
On the reverse, if you have a 80 year old lady who is not tachycardic with no physical findings of distress is the fact her bp is 80/60 going to prompt treatment?
Of course not.
Why so you can bill them?
People who call an ambulance don't always need a hospital. I stipulate they probably need healthcare. Most certainly don't need an ED (and the associated cost) and would likely be better served at a much reduced rate by a GP or urgent care.
Dr., honestly, how often does a single quantitative finding of anything sway your treatment one way or the other? 1%? 5%?
It is the totality of findings that create a clinical picture, not one. That doesn't change no matter what country you are from, what area of healthcare you practice in, or what level.
I am going to have to disagree and say they should be admitted to an inpatient service in the hospital. Pneumonia in the geriatric population is not going to resolve with the treatment done in the ED. I would even bet in your institution, there is an age criteria for discharging pneumonia patients from the ED.
??? You cannot be serious. If your neighbor asked you to look at their kid (out of hospital) and the kid had normal vitals and a temp of 99, you would suggest going to a hospital instead of an appointment with a pediatrician or an urgent care?
Really?
If that is the case, you are providing no better medical advice than the algorythms from nurse on call. I would be embarassed to say I was no more helpful than such. I would certainly lose considerable credibility among my superiors and peers.
Funny that, I said the same thing everytime I saw patients get a plethora of tests in the ED which take up far more time, resources, and cost in order to protect the doctor and hospital from legal action.
Ask yourself, does that really benefit the patient?
Before you answer that though, recall the burdon of proof and cost effectiveness required to institute routine health screenings for various diseases.
I am not trying to be a jerk (though I may be succeeding) but you cannot possibly demand more of paramedics and at the same time try to tell them what they are already doing doesn't make a difference anyway.
You cannot tell them not to do something that is standard for every other healthcare provider level in the world and not reduce them to more than a glorified taxi. (Even med techs learn to take temperatures)
Please spare me how the ED is going to save all the poor unfortunate souls of the world until they can admit patients to their service or can treat outpatient healthcare issues at the same cost and effectiveness as a PCP.
:rofl::rofl::rofl:
I can't help but find it funny. Not only do you both almost seem to be argueing the same thing, but one of you, or both, also have complained (appropriately) about the lack of education that US paramedics have for the amount of things that we can do.
Wouldn't it be better to focus on actually learning how to APPROPRIATELY apply the standard therapies that are being done before something else is added? I'm all for having a way to check a temp, but when to many people can't even figure out what they should do with the information that is currently being gathered...should something else really be added?
Or should the focus be on figuring out how to use what we have AND THEN adding more?
Being able to determine a core temperature (which most thermometers that I've seen commonly used won't gauge) is good to be able to do and can be an important piece of info. In certain cases (ROSC hypothermia, trauma patient's, anyone getting tylenol, and maybe sepsis patients) it should be mandatory. If someone wanted to check it on every patient because it is a "standard" vital sign that's fine; it doesn't take long to check and shouldn't distract anyone.
But...to play devil's advocate...
The arguement that it is a "standard" vital sign is fine but what is it changing? Hell, even in hospital, in most patients it is NOT being checked except at admission and maybe many hours later. Ignoring the specific instances I mentioned above, how often will knowing the exact temperature change your treatement? Will it really change things beyond subjectively realizing that your patient feels hot/cold/normal/warm/cool to the touch and has vitals signs consistent with someone with an elevated/decreased temperature? Hell, even in a septic patient, if you can't determine that that is the problem in the vast majority of cases WITHOUT knowing their exact temperature, then not having a thermometer is the least of your problems.
It goes right back to what I said above; perhaps before another tool is added the focus should be learning to use what we have.
Veneficus, haven't you mentioned in the past that in the part of Europe you're in many doctors focus more on their hands on exam and history and less on using multiple diagnostic tests? Perhaps this would be a time to implement that strategy here.
As I said in the post above, temperature is part of the total exam.
To address your concern, it doesn't always have to be exact. (not to omit cases when it does or when it may be useful)
You cannot tell if somebody has a fever simply by placing your hands on them. It is influenced by too many things. Like if you are wearing gloves or your skin temperature relative.
Examples how it comes into play.
Generally fever is a physiologic defense. Just because somebody has a fever, doesn't mean it should be treated. To do so would inhibit the normal physiologic defense to infection.
However, at some point, a fever can become pathologic, near this point, treating it is the lesser of two evils. Particularly if it is causing the pt considerable distress.
Because of the reliance of technology and lack of clinical accumen of many modern providers, specific numbers, charts, etc. have been developed to guide treatment. (it seems to me many providers on both sides of the pond rely too heavily on these to make decisions)
So somebody decided based on some research somewhere, that a fever should be treated if the quantitative measurement is equal or >40C.
Realistically, if your thermometer is a little off, is 1 or 2 degrees either way going to matter? No.
From another perspective, while a temperature does not always present in immunogenic pathology (like sepsis) when temperature is elevated prior to other more specific testing, it provides a clue as to the pathology of complaint. (so you don't always get a clue, it doesn't mean when you do it is less useful)
It is known in pathophysiology that a bacterial infection often causes a higher temperature that lasts longer. Could that perhaps be a clinical finding that is integrated into a clinical picture? (I certainly think so)
Now if you are one relying on those hard and fast numbers to help you with a diagnosis, well, what can I say? I'm sorry.
What really sets me off about this post isn't really the complaint about lack of paramedic education or intervention. It isn't the apparent tone of the response. (which is why I am not interested in all the who is a doctor who is a medic BS)
It is first the double standard.
You can't say "show me the evidence" and complain about effectiveness/cost in one area of medicine and not apply that same standard to your own.
Personally, I think a practicioner in order to be a credit to their specialty should demand a higher level of evidence from their peers than from others, but I would be ok with equal.
Also, as I keep pointing out. Just because you have a handful of studies (or less) you can't call that evidence. There are too many limitations.
You cannot only accept studies from people within your specialty. There is an inherent bias in that.
As well, there are limitations to scientific medicine. Not because I want there to be, because the observational methods are not perfect.
Second, like I said, you can't demand more from paramedics (or EMS) and then deny them the simplest of tools (which forces them below standard) because you claim it doesn't change what is done. I could pick out examples of diagnostics that do not change treatments in every discipline of medicne. But they are done because they support or refutes other findings.
I agree. Paramedic and EMS education in the states sucks. It is well below the standards of the rest of the modern world and needs changed.
No arguments there.
But, I can say without doubt, physical exam and history are the most important skills any provider can master.
Paramedics all over the world, including the US, are uniquely positioned to make great use of these skills as well as perfect them. (by virtue of the limited diagnostics they have)
That ability does alter treatment. It determines who gets a 12 lead based on suspicion. It determines who gets an IV, and at what rate. It determines medication administration decisions. What protocol to follow. What transport destination. The list goes on.
Yes, paramedics have to learn to use the tools they have before it is reasonable to give them more. But the ability to take a full set of vital signs and integrate those findings into their differential Dx, is something they need to be able to use today, if they can't they are unacceptably deficent.
I am not saying temperature will always be a useful indicator, but as experience does play a role in provider decision making, I have an anecdote.
I was a relatively yound paramedic and it was drilled into me that temperature is a vital sign. That it should be taken as part of such. More so that capilary blood sugar and spo2.
So I was on an FTO period as a new employee. We went to a call of "difficulty breathing." Found an elderly lady tripoding, definately difficulty breathing. She had dependant edema, a history so long it read like a pathology review but CHF was in there and she did have her own bottle of furosimide. Gave her some oxygen, EKG, 12 lead, albuterol, heard the crappy lung sounds, FTO prompted me that furosimide would be indicated in this lady.
But I thought, furosimide is contraindicated in pneumonia. (for paramedics of that period in history) CHF patients are prone to pneumonia. So I took a temperature. Which was elevated. I elected not to give the furosimide because of the temperature. In my mind it stood to reason, she takes furosimide, doesn't have this level of difficulty breathing every day, what makes today different?
Because the FTO was hell bent on finding the official Dx (because I am sure he was looking for something negative to say about my not following the protocol like a cookbook, he was one of those guys) the official admitting dx was pneumonia.
It was the only time in my career as a medic temperature changed anything. But it did. While I would like to say it was an amazing finding that helped the pt. The truth is, it probably helped me more because I didn't get dinged for not following the cookbook and I had an iron clad reason.
Is it possible she would have had pneumonia and not have an elevated temperature? Of course it is. Would I have given her the furosimide if she didn't have an elevated temperature? I speculate I most certainly would have, of not by my choosing than by order of the FTO.
Maybe giving her the med would have changed nothing in her condition, I am not saying withholding the treatment altered anything for her.
But the finding did alter my treatment decision.
Admittedly, I cannot recall taking a temperature ever again made a difference to me as a paramedic.
It is likely now that furosimide is largely being removed from prehospital medicine, such a situation will never happen again.
But really, what does a thermometer cost to operate?
A few dollars over it's life to sometimes provide information that can sometimes be intergrated into a physical exam?
Really if you want to impress me with picking a fight on what shouldn't be on an ambulance, start with cardiac arrest medications or long spine boards.
or the damn MAST. (PASG) whatever you want to call it.
The study showing they are effective at bleeding control in a ruptured AAA with a systolic BP below 50mmhg really didn't impress me.
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I'm not looking for a fight about anything. I think the ability to check a temp should be one that paramedic's have. Like I said above, if certain things are done, or situations encountered it should be mandatory. And even if it's not, I've got no problem if someone wants it checked on everyone.
I also don't work with a bunch of effing morons. Many do. In looking at EMS as a whole, adding something, however small it may be without knowing what to do with it, or how to integrate it into everything else that is found is asinine.
It's why things are so :censored::censored::censored::censored:ed up right now. "Wow...we can do this in the field and it'll make our job so much easier! But we won't teach anybody about it, after all it's so simple we don't need to! And even better, we can stop teaching them about something else because of this new thing!"
Sound familiar?
No, you can't always tell if someone is febrile by touching them (and if someone checks that with their glove on it illustrates my point about needing to know how to work with what we have before adding more); but more often than not you can. And if you add in the patient's history, physical, surrounding, etc etc (all those things that we are SUPPOSED to know how to interpret) you should be able to figure it out the vast majority of times. Admittedly, not always though. Hence why I do like the ability to check.
Taking sepsis for example. As you said, a fever may or may not be there. Knowing if there is one will definetly help with determining, but it should not be the deciding factor; if you don't know the exact temp but still do a thourough exam and take a good history...you should have a good idea about what is going on. I know. I'm repeating myself.
Look at the patient you mentioned for instance. Looking back on it, can you honestly say that, based on what you asked and saw then, and what you would have seen/asked knowing what you do now, was knowing a specific temperature the only thing that pointed towards pneumonia? Or was there more?
From my own experience, excluding the types of patient's I've mentioned previously, I can't honestly say that my treatement or assessment of a patient was every changed by knowing their exact temperature. Even in patient's that I've given tylenol to, it was clear that they were febrile before I had a number value. For patien'ts like the one you talked about, there have been things in their history and exam that made me lean towards pneumonia instead of CHF. And I'm a :censored::censored::censored::censored:ing average paramedic; if I can figure this out then anyone should be able to.
Obviously, I may be forgetting specific cases, and none of that means that it won't be something that changes what I do in the future.
I don't know where I'm going with this beyond depressing myself. Should a paramedic have the ability to check a temp? I agree they should. Should they need to check one to make an appropriate diagnosis in most cases? No. Should it be used as a crutch to make up for a poor assessment? No. Do they need to know how to integrate that information into the rest of their exam? Yes.
Right now, as a country, we aren't there.
I also don't work with a bunch of effing morons. Many do. In looking at EMS as a whole, adding something, however small it may be without knowing what to do with it, or how to integrate it into everything else that is found is asinine.
It's why things are so :censored::censored::censored::censored:ed up right now. "Wow...we can do this in the field and it'll make our job so much easier! But we won't teach anybody about it, after all it's so simple we don't need to! And even better, we can stop teaching them about something else because of this new thing!"
Sound familiar?
No, you can't always tell if someone is febrile by touching them (and if someone checks that with their glove on it illustrates my point about needing to know how to work with what we have before adding more); but more often than not you can. And if you add in the patient's history, physical, surrounding, etc etc (all those things that we are SUPPOSED to know how to interpret) you should be able to figure it out the vast majority of times. Admittedly, not always though. Hence why I do like the ability to check.
Taking sepsis for example. As you said, a fever may or may not be there. Knowing if there is one will definetly help with determining, but it should not be the deciding factor; if you don't know the exact temp but still do a thourough exam and take a good history...you should have a good idea about what is going on. I know. I'm repeating myself.
Look at the patient you mentioned for instance. Looking back on it, can you honestly say that, based on what you asked and saw then, and what you would have seen/asked knowing what you do now, was knowing a specific temperature the only thing that pointed towards pneumonia? Or was there more?
From my own experience, excluding the types of patient's I've mentioned previously, I can't honestly say that my treatement or assessment of a patient was every changed by knowing their exact temperature. Even in patient's that I've given tylenol to, it was clear that they were febrile before I had a number value. For patien'ts like the one you talked about, there have been things in their history and exam that made me lean towards pneumonia instead of CHF. And I'm a :censored::censored::censored::censored:ing average paramedic; if I can figure this out then anyone should be able to.
Obviously, I may be forgetting specific cases, and none of that means that it won't be something that changes what I do in the future.
I don't know where I'm going with this beyond depressing myself. Should a paramedic have the ability to check a temp? I agree they should. Should they need to check one to make an appropriate diagnosis in most cases? No. Should it be used as a crutch to make up for a poor assessment? No. Do they need to know how to integrate that information into the rest of their exam? Yes.
Right now, as a country, we aren't there.
sorry
I meant collective "you," not you personally.
To answer your question honestly, aside from the history and suspicion of new onset, temperature was all I had to defeat the cookbook. So I went with it.
If it makes you feel better, I use serial temperatures on my daughter when she gets sick to decide if I will give her something or not.
I know when she is sick without the temp. But I guess you could say it guides my decision. But I give it a +/-1
I meant collective "you," not you personally.
To answer your question honestly, aside from the history and suspicion of new onset, temperature was all I had to defeat the cookbook. So I went with it.
If it makes you feel better, I use serial temperatures on my daughter when she gets sick to decide if I will give her something or not.
I know when she is sick without the temp. But I guess you could say it guides my decision. But I give it a +/-1