# Temperature



## mikie (Apr 25, 2008)

Does anyone carry thermometers on their rig?

I know we are to check temperature via skin, but would it be helpful to get a more accurate reading*?  

*assuming the pt. is stable to take an oral temp...

Temperature can tell us a lot about a pt...or would it not have much use prehospital?


So what are your thoughts?

Thanks!


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## JPINFV (Apr 25, 2008)

We didn't carry thermometers on the ambulance, but it would have been nice to have.


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## Ridryder911 (Apr 25, 2008)

Yes, we carry them.. I also request rectal ones too, core temp is a *vital* sign. You don't check temp.'s for febrile seizures, heat stroke, when you transport blood products?

R/r 911


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## TheMowingMonk (Apr 25, 2008)

My crew carries digital ones and disposable ones depending on how accurate we want them to be, they are a good thing for dealing with flu or other illness to be able to get a temp on top of all the other things Rid mentioned


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## emtwacker710 (Apr 25, 2008)

we recently got them at our squad, within the last year or so, we only carry the digital oral ones with the little disposable covers.


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## medicdan (Apr 25, 2008)

I just realized we carried them, AFTER a call where I would really have liked one. On arrival in the ER, my pt had a temp of 105.8-- It turned out to be a pylon-- a kidney infection, but it scared the **** out of me. 
We have those plastic disposable ones where dots change color based on the temp...


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## CFRBryan347768 (Apr 25, 2008)

Ridryder911 said:


> Yes, we carry them.. I also request rectal ones too, core temp is a *vital* sign. You don't check temp.'s for febrile seizures, heat stroke, when you transport blood products?
> 
> R/r 911



When would you use a rectal one? I certainly know no 1's stickin anything in their if im alert and orientedB)


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## Ridryder911 (Apr 25, 2008)

CFRBryan347768 said:


> When would you use a rectal one? I certainly know no 1's stickin anything in their if im alert and orientedB)



LOL...I understand, but core temp is the only real temp that is dependable in emergency situations. The tympanic type is to unreliable because most are not able to achieve deep enough past the ear canal, and wax build up, etc., as well as febrile temperature can alter the results. 

R/r 911


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## CFRBryan347768 (Apr 25, 2008)

Ridryder911 said:


> LOL...I understand, but core temp is the only real temp that is dependable in emergency situations. The tympanic type is to unreliable because most are not able to achieve deep enough past the ear canal, and wax build up, etc., as well as febrile temperature can alter the results.
> 
> R/r 911



So have you actually come across a patient that said, "I understan you gotta do this go ahead." Or somethign like that?


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## lfsvr0114 (Apr 25, 2008)

We carry tympanic thermometers.  We are supposed to take a temp on everyone.


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## MSDeltaFlt (Apr 25, 2008)

CFRBryan347768 said:


> When would you use a rectal one? I certainly know no 1's stickin anything in their if im alert and orientedB)



There are ER MD's who will order one on *any* adult who is tachypneic.  You would not believe how big the variance is on temps on a febrile pt who is breathing fast and through their mouth.


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## Ridryder911 (Apr 25, 2008)

On a sick or critical patient, taking an temp other than rectal is useless. If you really want to know their temp is then a rectal (core) will be performed. Again on really ill or injured patients, I have done more rectal temps than oral/tympanic/axillary. 

Again, this is just part of medicine. Something that may not be seen a lot, but should be expected. 

R/r 911


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## BossyCow (Apr 25, 2008)

We carry both oral and rectal in the old fashioned glass thermometers. Also carry Tympanic and digital oral, but those can be unreliable in colder weather.


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## CFRBryan347768 (Apr 25, 2008)

MSDeltaFlt said:


> There are ER MD's who will order one on *any* adult who is tachypneic.



So in other words this would mean you cant deny them sticking it in you?


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## Ridryder911 (Apr 25, 2008)

Oh, you can deny... but it may alter the treatment plan. I have seen physicians basically tell patients they will not be receiving any medications since they are refusing an assessment procedure and thus care. It is an uncomfortable but not considered a painful procedure, much better than a rectal or lumbar spinal tap, or insertion of a Foley catheter to diagnose the illness. Generally, I do not hear much complaints, most patient that are febrile are to ill to argue and just want to be treated. 

Patients that are febrile need to be thoroughly assessed. Sepsis and other conditions such as head injuries, spinal injuries, even AMI's may cause fluctuations in the body temp. 

I agree, it is not a routine procedure in the field, and do not endorse such, but on cases regarding febrile presentations it should be assessed if possible. 

R/r 911


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## mikie (Apr 25, 2008)

During my ER clinical, I took pt's temperature w/ a tymapnic one (that's the one they gave me, I wasn't permitted to do rectal ( oh well!)

I does seem unreliable...a lot of pt's temps were in the low 97s and I really doubt it was their core temp.  The nurses told me to push hard and I did...still similar results.  I would often take it more than once (one in each ear at least)


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## Airwaygoddess (Apr 26, 2008)

*Thermometers*

I have just gotten two of these for our program, I have used this thermometer at other jobs, very well made and very accurate!

Welch Allyn Suretemp Plus Eletronic Thermometer modal 690
Our internship program does quite a few medical standbys during the summer, and we get many environmental emergencies.  I am happy to hear that temperatures are now being checked more in the field.


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## TKO (Apr 26, 2008)

I have on car both tympanic and oral thermometers, and because it is the cold north of Canada, we can perform a rectal temp on pts with suspected severe hypothermia.

Luckily, I have never had the displeasure.


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## MAC4NH (Apr 27, 2008)

We carry a digitial tympanic thermometer on our volunteer unit.  Both paid services I work for don't carry them.  They are useful.  They are considered optional in this state so the paid services aren't going to use them until they're mandatory.


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## Flight-LP (Apr 27, 2008)

We carry them and record a temperature on every patient, continuous temperature monitoring on all pts. that we induce hypothermia on...............


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## snaketooth10k (May 22, 2008)

*What? What? In the butt?*



CFRBryan347768 said:


> When would you use a rectal one? I certainly know no 1's stickin anything in their if im alert and orientedB)



You can only use a rectal or IR thermometer on infants. Keep that in mind because it is *VERY BAD* to take an oral on infants in most cases, mostly because they don't cooperate and it's hardly accurate.


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## Ridryder911 (May 22, 2008)

snaketooth10k said:


> You can only use a rectal or IR thermometer on infants. Keep that in mind because it is *VERY BAD* to take an oral on infants in most cases, mostly because they don't cooperate and it's hardly accurate.



Who said you can only take rectal on infants? Better explain how you get a true "core temp"; as I do rectal temps on adults every day. 

R/r 911


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## mikeylikesit (May 23, 2008)

so I guess just putting your lips on the patients forhead is out then?^_^


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## fma08 (May 24, 2008)

we only have tympanics but i wish we at least had orals


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## Ridryder911 (May 24, 2008)

mikeylikesit said:


> so I guess just putting your lips on the patients forhead is out then?^_^



Definitely, not checking a rectal by that means


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## Raf (May 26, 2008)

We don't carry thermometers nor were we ever taught anything about specific temperatures. Just touch the forehead with the back of your gloved hand and decide cool, warm or hot, that's about as detailed as we get.


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## Ridryder911 (May 26, 2008)

Raf said:


> We don't carry thermometers nor were we ever taught anything about specific temperatures. Just touch the forehead with the back of your gloved hand and decide cool, warm or hot, that's about as detailed as we get.



How sad.... You were not taught about vital signs...

R/r 911


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## TheMowingMonk (May 26, 2008)

hell in my county BLS isnt even allowed to take temperatures, it is considered as ALS skill which is so stupid its not even funny.


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## sabbymedic (May 26, 2008)

In Ottawa where I work Temp is one of the standard VS now. We carry tempanic thermometers but they are not always the most accurate. Especially in the cold and flu season we use them a lot, at least I do. Taking a temp is a good idea because it may be a helpful indicator that you need to use full PPE Mask, Gown, Gloves and Eyewear etc. Hope this helps.

Sabby


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## mikeylikesit (May 26, 2008)

yeah taking temps is so hard that only medics and moms can do it.:glare:


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## BossyCow (May 27, 2008)

Has anyone else had issues with the digital thermometers not functioning well in colder temps? That's why we always keep a good old fashioned glass thermometer in the kit.


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## Ops Paramedic (May 28, 2008)

Remember that the most important difference between a *Rectal *and an *Oral *thermometer is: *The taste*!??!

On a more serious note, we dont carry them on the ambos.  Selected ALS carry them, but they are not used routinely.  We would mainly use them for kids with convulsions and drownings.  Should i a temp, it will most likely be rectal as the reading is more accurate.  We also carry Sub normal theremometers, specially for the drownings and hypothermic cases.


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## mikeylikesit (May 28, 2008)

i wouldn't imagine that BLS trained personnel would know what to do in certain temp ranges without some A&P knowledge. some temps are good as they are the bodies way of fighting and beating bacteria and some virus. anything obove 105 F is cutting it, and they should be chilled. be careful cause you can quickly spin them in the other direction and make lessen the process of your bodies immune systems attempt at defeat.


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## PapaBear434 (May 28, 2008)

Ridryder911 said:


> How sad.... You were not taught about vital signs...
> 
> R/r 911



I was taught the same way, though we do have inner ear thermometers so that if someone is extremely warm and we have time (no major life threats) we can get the stat to pass along to the ER.

But for standard documentation?  Just warm, cool, dry, moist, pale, flush...  That's really about it.


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## Ridryder911 (May 28, 2008)

PapaBear434 said:


> I was taught the same way, though we do have inner ear thermometers so that if someone is extremely warm and we have time (no major life threats) we can get the stat to pass along to the ER.
> 
> But for standard documentation?  Just warm, cool, dry, moist, pale, flush...  That's really about it.



Just unfortunate one has to say they were not taught how to take and record vital signs, the basics of life. 

R/r 911


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## sabbymedic (May 28, 2008)

Not sure how one goes through a medic program and does not learn how to record vitals. I learnt that in the first few weeks of my program. The usual about touching the skin to see if it is cool warm wet dry etc. are basics. Taking an actual temp is a big one that has come out ever since SARS that is why the Ministry of Health has made it one of the regular vital signs that need to be recorded.


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## PapaBear434 (May 29, 2008)

Ridryder911 said:


> Just unfortunate one has to say they were not taught how to take and record vital signs, the basics of life.
> 
> R/r 911



That's just it:  Temperature isn't considered a vital for BLS.  We deal in immediate and obvious life threats.  Are they abnormally hot or cold?  That's good enough for our purposes.  Anything more involved is going to need an ALS intervention to fix anyway.


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## BossyCow (May 29, 2008)

PapaBear434 said:


> That's just it:  Temperature isn't considered a vital for BLS.  We deal in immediate and obvious life threats.  Are they abnormally hot or cold?  That's good enough for our purposes.  Anything more involved is going to need an ALS intervention to fix anyway.



What??? Actually temperature is a vital sign and an important one and yes we can do something about it. 

If someone has a lowered core temp due to exposure, you know, the little old lady who fell and lay on her cold tile bathroom floor for hours in a puddle of urine... I'd sure like to have a temp on her because she may or may not be coherent enough to tell me how cold she is. And yes the number does matter, because "I feel warmer now" isn't nearly as effective as "her initial temp was .... and now she's ......"

Having an initial temp to give the ER on your feverish pt is nice as a comparison. Is the fever rising, stable, decreasing? Good information to have. Just because the pt may need ALS intervention is no excuse for not doing a thorough evaluation and doing it well. Part of our job is to note and record trends, and changes in our pts condition. Baseline vitals are part of that. ALS or not, and temp is a vital sign.


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## JPINFV (May 29, 2008)

PapaBear434 said:


> That's just it:  Temperature isn't considered a vital for BLS.  We deal in immediate and obvious life threats.  Are they abnormally hot or cold?  That's good enough for our purposes.  Anything more involved is going to need an ALS intervention to fix anyway.


Why take a blood pressure? There are people whose normal BP is what is considered hypotensive, but they don't need to be rushed to the hospital. Furthermore, we can't do anything for a low BP besides call ALS and transport.

Why look at pupils? Regardless of what is going on, we can't do anything for it besides ALS and transport. 

Why listen to breath sounds? We can't do anything for it if it's bad anyways.

Hell, why even have BLS providers do an exam anyways?. It's going to be call ALS, immediate transport, and high flow oxygen (regardless of if they need oxygen or not) if it's anything even moderately serious. 

The "Well, by gosh. Gee wiz, we can't do anything about it anyways" is a lazy answer. I'd much rather have an actual number than a hunch based on the hairs on the back of my gloved hand.


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## laina66 (May 29, 2008)

:unsure:We actually switched back to our old thermometer---the fancy one is too touchy. The normal reading thermometer works perfectly fine so why bother?


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## PapaBear434 (May 29, 2008)

Wow, I hit a nerve there.  I'm not disagreeing with you guys that it's a vital, and pretty damn important.  However, as a guy who just got out of training a couple of weeks ago, the new standard says your vitals are *pupils, BP, pulse, skin* (this included temperature), and *respirations*.  Hell, even lung sounds aren't considered a vital, but instead a step in assessment of the lungs only. 

Maybe it's just a Virginia thing, but that's the way it is.  BLS is little more than tow truck drivers, hauling the cars (patients) to the mechanic (hospital), hopefully without causing any more damage than when we initially picked them up with.  They keep us pretty limited.  In fact, over half of the jurisdictions don't even allow anything under Paramedic level place an advanced airway, under the idea that EMT-I and below wouldn't do it enough to maintain a high enough proficiency.  

I know, as it's obvious, that temperature is important.  But as far as the training is concerned, taking an exact temperature is going the extra mile, not standard care.


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## firecoins (May 29, 2008)

We aren't allowed to check for core temp through a rectal temp where we work. So we are stuck using inaccurate methods if we have those tools available.  We usually don't.  I guess we will be stuck treating the patient via MOI/NOI, chief complaints and obvious signs of fever, cold or heat injuries.  It works for now.


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## mikeylikesit (May 30, 2008)

firecoins said:


> We aren't allowed to check for core temp through a rectal temp where we work. So we are stuck using inaccurate methods if we have those tools available.



don't worry....you wont find too many volunteers for that anyways...or for practice for that matter.


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## firecoins (May 30, 2008)

mikeylikesit said:


> don't worry....you wont find too many volunteers for that anyways...or for practice for that matter.



I am not too worried.


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## Ridryder911 (May 30, 2008)

PapaBear434 said:


> That's just it:  Temperature isn't considered a vital for BLS.  We deal in immediate and obvious life threats.  Are they abnormally hot or cold?  That's good enough for our purposes.  Anything more involved is going to need an ALS intervention to fix anyway.



All I can say is wow!.. I'll let the BLS providers speak..

R/r 911


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## BossyCow (May 30, 2008)

PapaBear434 said:


> Wow, I hit a nerve there.  I'm not disagreeing with you guys that it's a vital, and pretty damn important.  However, as a guy who just got out of training a couple of weeks ago, the new standard says your vitals are *pupils, BP, pulse, skin* (this included temperature), and *respirations*.  Hell, even lung sounds aren't considered a vital, but instead a step in assessment of the lungs only.



I'm confused. You say that temp is included with skin but not a vital? Sounds like it is to me. If temp is included, it should be taken and taken accurately.



> Maybe it's just a Virginia thing, but that's the way it is.  BLS is little more than tow truck drivers, hauling the cars (patients) to the mechanic (hospital), hopefully without causing any more damage than when we initially picked them up with.  They keep us pretty limited.  In fact, over half of the jurisdictions don't even allow anything under Paramedic level place an advanced airway, under the idea that EMT-I and below wouldn't do it enough to maintain a high enough proficiency



There is a huge difference between placing an ET tube and taking a temp. Surely you are not suggesting that taking an accurate temp is an ALS skill. Now, if you believe that your state's standards are low, you can either sink to that standard or rise above them. Your standard of care and your dedication to your skill set needs to be a personal thing, not state mandated. Sure the state will say you can't do some skills without proper education and training, but how well you do patient care within your scope is up to you.



> I know, as it's obvious, that temperature is important.  But as far as the training is concerned, taking an exact temperature is going the extra mile, not standard care.



Darlin'... let me say this about that... GOING THE EXTRA MILE IS STANDARD CARE!


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## PapaBear434 (May 30, 2008)

BossyCow said:


> I'm confused. You say that temp is included with skin but not a vital? Sounds like it is to me. If temp is included, it should be taken and taken accurately.
> 
> 
> There is a huge difference between placing an ET tube and taking a temp. Surely you are not suggesting that taking an accurate temp is an ALS skill. Now, if you believe that your state's standards are low, you can either sink to that standard or rise above them. Your standard of care and your dedication to your skill set needs to be a personal thing, not state mandated. Sure the state will say you can't do some skills without proper education and training, but how well you do patient care within your scope is up to you.
> ...



You misunderstand.  Skin temp is just using the back of the hand to feel the skin.  Is it hot or cool, dry or moist.  That's IT.

I am not equating an ET tube with temperature taking.  I used that as an example of how much VAEMS likes to hobble their providers under the assumption that in most places a hospital is within less than fifteen minute driving distance.  

I won't deny that going the extra mile isn't what we should all strive for.  What I said is that as far as the training goes, feeling the skin is "good enough" for us.  

You guys are confusing my arguments with that of the training I received.  Don't kill the proverbial messenger.


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## Airwaygoddess (May 30, 2008)

*Patient care.........*

Checking a patient's temperature should be part of the vital signs for BLS and ALS calls.  This is would be considered part of the patient's assessment.  First and foremost, the ABC's should be checked, any problems corrected, and continue with on going care.

  With the continuing  rise of patients that are discharged from the hospital after having invasive tests and or procedures done, anywhere from 8 to 48 hours post procedure is alarming.  Gone are the days for a patient that would have had a "standard" surgical procedure, stay in the hospital for a minimum of 3-4  days, received bedside care and monitoring.  At this point, if the patient had any surgical drains, they would have been removed by the doctor.  Discharge teaching would have been done by the nursing staff and the patient would have been discharged home.

  Patients are being discharged home sooner with surgical drains, foley catheters, intravenous devices and feeding tubes.  What needs to be remembered that these devices are a common route for sepsis to occur, with patient's immune system is already compromised, age and disease process also contribute greatly to this condition.

  Many hospitals across the United States are implementing a sepsis protocol that starts in the emergency department when the patient arrives.  I strongly believe that by checking a patient's temperature in the field with baseline vital signs and with the ongoing assessment, will contribute to the continuum of care that is much needed for the best patient outcome.  I also think that a sepsis protocol should be developed and implemented for pre hospital care, this in turn would be beneficial for the continuum of patient care.

  Environmental emergencies would also call for the monitoring of a patients temperature.  Once again this should also be a standard part of the patient's vital signs and ongoing assessment and treatment, after the ABC's have been assessed and corrected as needed.  If the patient's condition requires a core temperature, then it is important to be to preform this function with the proper training and professionalism that is required for our job.  I, at times grow very tired of the "rectal jokes" and the "that gross!" attitude.  Gross is when you run a child or elder abuse call, and see what another human being has done to a helpless soul.  Gross is arriving on scene to a pediatric drowning and seeing the firefighters trying to get a pulse back on a 2 year old with a unknown down time, and the parents saying, "I only looked away for just a minute!"  

  It is our professional obligation and positive attitude that requires us provide the best pre hospital care possible to the public through education, training and quality improvement, to set a strong example for the for up and coming and brand new pre hospital care providers.  The bottom line is this, we are the patient's advocate in the field, we give that patient a fighting chance....
  Respectfully submitted.....-_-


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## mikeylikesit (May 30, 2008)

If they feel hot...cool them down. If they feel cool, heat them up. if they are wet dry them off. If they are dehydrated moisten them up (get your mind out of the gutter) it is not so hard right? (Mild sarcasm.)


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## VentMedic (May 30, 2008)

mikeylikesit said:


> If they feel hot...cool them down. If they feel cool, heat them up. if they are wet dry them off. If they are dehydrated moisten them up (get your mind out of the gutter) it is not so hard right? (Mild sarcasm.)



That is not always true.   

Many people with sepsis will feel cool and almost cold to touch while their core temp is 104.   EMTs and Paramedics have actually argued with RNs at nursing homes "they don't feel hot to me, what make you think they have a fever?".   They took a rectal temp, that's how.   I hear these same uneducated remarks in the ED.  The Paramedics actually think they have made some statement about the NH's stupidity when all they did was lose credibility in the ED.


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## BossyCow (May 30, 2008)

> You misunderstand.  Skin temp is just using the back of the hand to feel the skin.  Is it hot or cool, dry or moist.  That's IT.



I don't 'misunderstand' I disagree. Using the back of the hand to check a temp assumes that your hand is an accurate measure of temp. If your hands are cold, the pt will feel warmer than they actually are or if your hands are warm, the pt will feel cooler than in actuality. Using a hand to aproximate skin temp is not taking a vital, nor should be be. Checking that way, is part of assessment but not a vital. A vital is a temp and is done with a thermometer.



> I am not equating an ET tube with temperature taking.  I used that as an example of how much VAEMS likes to hobble their providers under the assumption that in most places a hospital is within less than fifteen minute driving distance.



Insisting that a provider have the training to support an invasive skill is not 'hobbling' but is being responsible. You bring this up in support of your argument but I can't see its relevance to the temperature taking.



> I won't deny that going the extra mile isn't what we should all strive for.  What I said is that as far as the training goes, feeling the skin is "good enough" for us.



I'm confused, are you saying that feeling the skin is all you were taught to do, all you are allowed to do, or all you feel you should do? Temperature is a vital sign. Period. If you are supposed to take vitals, then you should take all of them and take them accurately. If you are more than 15 minutes from a hospital, you have the time, do the temp. (Our average transport is 20+ minutes)



> You guys are confusing my arguments with that of the training I received.  Don't kill the proverbial messenger.



Well, our confusion is in response to your post. Your initial post sounded like.."Hey, my system sucks and doesn't care, so why should I do more than the minimum"


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## Ridryder911 (May 30, 2008)

PapaBear434 said:


> the new standard says your vitals are *pupils, BP, pulse, skin* (this included temperature), and *respirations*.




When did pupils become a vital sign? Many medical schools are not even teaching to check pupils such as in PEARL anymore. Do you really know what it means when they are not.. (No I don't mean head injury) ? Is it normal to have unequal pupils, or if they are sluggish or lack accommodation? When there is so much better and more detailed neurological evaluations out there. Heck, pupils should only be checked in secondary examination, not even included in a primary evaluation. 

Vital signs have always been and will always be: 

Temperature
Pulse
Respiration's 
Blood Pressure

That is the essentials, anything more is just that additional information important yes but not considered vital signs. Vital Signs are regarded as the most important signs representing the patients condition. If you were taught other than that, they were wrong.. period. 

R/r 811


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## mikeylikesit (May 30, 2008)

VentMedic said:


> That is not always true.
> 
> Many people with sepsis will feel cool and almost cold to touch while their core temp is 104. EMTs and Paramedics have actually argued with RNs at nursing homes "they don't feel hot to me, what make you think they have a fever?". They took a rectal temp, that's how. I hear these same uneducated remarks in the ED. The Paramedics actually think they have made some statement about the NH's stupidity when all they did was lose credibility in the ED.


....hence the last two words of my post. "Mild Sarcasm"
i'm not an idiot i do have a lot of training in medical far beyond that of a paramedic. but for a basic these "should be good guidelines" to follow based on enviormental factors that they can see and feel...not every situation that they may encounter.


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## PapaBear434 (May 30, 2008)

I don't think there is any way for me to get this across.  I agree with you guys.  I take temp any time I am able.  But our protocols say pupils, respirations, BP, pulse, and skin (general term) are our vitals.  It even has those five designated in our PCR.  Temperature is only allowed a spot on the ALS PCR sheets.  

I can't stress this enough:  I AGREE WITH YOU GUYS.  I am just saying that either training has changed, or training standards have severely slackened.


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## Ridryder911 (May 30, 2008)

PapaBear434 said:


> I don't think there is any way for me to get this across.  I agree with you guys.  I take temp any time I am able.  But our protocols say pupils, respirations, BP, pulse, and skin (general term) are our vitals.  It even has those five designated in our PCR.  Temperature is only allowed a spot on the ALS PCR sheets.
> 
> I can't stress this enough:  I AGREE WITH YOU GUYS.  I am just saying that either training has changed, or training standards have severely slackened.




No problem, with you.. Just your protocols and education criteria needs to be on track...

R/r 911


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