# Thermometers



## OnceAnEMT (Jul 3, 2014)

Naturally, temperature is a vital sign. So what model/brand or type of thermometers are y'all using on your rigs or just have in your gear? I'm looking to get one for use in SAR, but I am spoiled at work by the $300+ WelchAllyn beasts. At the same time, I am hesitant to bother with a CVS-branded "8 second" thermometer. I'm looking to find some middle ground, or just say screw it and get the cheap ones and hope the EMS system supporting us has thermometers.


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## NomadicMedic (Jul 3, 2014)

Kind of pointless in SAR. If they're hot, cool them. If they're cold, warm them.


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## OnceAnEMT (Jul 3, 2014)

DEmedic said:


> Kind of pointless in SAR. If they're hot, cool them. If they're cold, warm them.



Which is why I'm not too hesitant to say screw it, but I'm willing to see if there is a feasible solution.


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## vcuemt (Jul 3, 2014)

I took a temp yesterday for the very first time because the mom wanted to know. He had a nice little fever (104.5) but knowing that info didn't change any of the patient care decisions we made. The thermometer we used was just like the one I'd have at home if I was a parent.


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## spnjsquad (Jul 3, 2014)

vcuemt said:


> I took a temp yesterday for the very first time because the mom wanted to know. He had a nice little fever (104.5) but knowing that info didn't change any of the patient care decisions we made. The thermometer we used was just like the one I'd have at home if I was a parent.


104.5 isn't a nice little fever, that's extremely high. I would consider a "nice little fever" as something like 100.1 or 101.1.


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## TheLocalMedic (Jul 6, 2014)

My agency buys these el-cheapo temporal thermometers that don't work worth a darn.  They break easy and aren't reliable at all...  I sincerely wish we'd invest in some decent ones...


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## LACoGurneyjockey (Jul 6, 2014)

spnjsquad said:


> 104.5 isn't a nice little fever, that's extremely high. I would consider a "nice little fever" as something like 100.1 or 101.1.



someone (vcuemt) may have forgot to hit the sarcasm button...


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## JPINFV (Jul 6, 2014)

spnjsquad said:


> 104.5 isn't a nice little fever, that's extremely high. I would consider a "nice little fever" as something like 100.1 or 101.1.



100.1 is not a fever.


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## JPINFV (Jul 6, 2014)

vcuemt said:


> I took a temp yesterday for the very first time because the mom wanted to know. He had a nice little fever (104.5) but knowing that info didn't change any of the patient care decisions we made. The thermometer we used was just like the one I'd have at home if I was a parent.




1. What's the criteria for SIRS/Sepsis?

2. "If you don't take a temperature, you can't find a fever." -House of God.


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## NomadicMedic (Jul 6, 2014)

Temp is only one entry point for our sepsis protocol. I'm usually more inclined to activate on a >4.0 mmol/L lactate (with other clinical signs) We have "temp strips that show a round number temp and axilla probes for use with the Lifepak.


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## AVParamedic1 (Jul 7, 2014)

for my personal kit I have a BRAUN ThermoScan which is just a cheaper version of the Welch Allyn ThermoScan Pro4000, very good and reliable. the local hospital has changed to the BRAUN from the Welch Allyn as it is cheaper.
cost around $70-$80 in Australia compared to $200 for the Welch Allyn


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## vcuemt (Jul 7, 2014)

JPINFV said:


> 1. What's the criteria for SIRS/Sepsis?
> 
> 2. "If you don't take a temperature, you can't find a fever." -House of God.



I'm not sure I 100% trust that number, but it's what the thermometer said so it's what I wrote down. The person was sick, don't get me wrong, but not in any critical kind of way.


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## Drax (Jul 7, 2014)

vcuemt said:


> I'm not sure I 100% trust that number, but it's what the thermometer said so it's what I wrote down. The person was sick, don't get me wrong, but not in any critical kind of way.



Definite recommendation of being seen at the hospital and BLS transport. I'd even retake that temperature. Whether I thought the device was good or not, it is the device my service provided to me, that is the information it gave, and I would act accordingly based on the reading and protocols. If this were an environmental emergency, then it would be near criteria for ALS upgrade.

Granted that is for environmental emergencies. So if you were just seeing a patient for cold/flu-like symptoms. I'd probably consult with ALS. Either way, recommend transport.

What do your protocols say?


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## Desette (Jul 8, 2014)

For search and rescue I pack these in my bag:


http://www.amazon.com/gp/aw/d/B0008GCVSA?pc_redir=1404738742&robot_redir=1


http://www.amazon.com/gp/aw/d/B000G...3aedbafb835ba&pi=SL500_SS115#ref=pd_aw_sims_1

No way I am packing a full size if I can get away with it. They use these in some NICU / PICU departments as well


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## rails (Jul 11, 2014)

Our thermometers are very basic -- just cheap thermometers with a stack of sheaths available. I would like something better, but I'm leary to spend my own money.


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## JPINFV (Jul 11, 2014)

DEmedic said:


> Temp is only one entry point for our sepsis protocol. I'm usually more inclined to activate on a >4.0 mmol/L lactate (with other clinical signs) We have "temp strips that show a round number temp and axilla probes for use with the Lifepak.




Well, lactate isn't a criteria for SIRS/SEPSIS. It is for severe sepsis and septic shock... which is what people generally care about. That said, just because a septic patient doesn't make it into alert criteria yet for severe sepsis doesn't mean you shouldn't have an increased index of suspicion for a patient who clinically looks sick and meets sepsis criteria (HR, RR or PaCO2, Temp, and WBC or Bands, granting that most people can't check PaCO2 or WBC/Bands).


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## TransportJockey (Jul 11, 2014)

JPINFV said:


> Well, lactate isn't a criteria for SIRS/SEPSIS. It is for severe sepsis and septic shock... which is what people generally care about. That said, just because a septic patient doesn't make it into alert criteria yet for severe sepsis doesn't mean you shouldn't have an increased index of suspicion for a patient who clinically looks sick and meets sepsis criteria (HR, RR or PaCO2, Temp, and WBC or Bands, granting that most people can't check PaCO2 or WBC/Bands).



Our sepsis criteria involves lactate, HR, temp, ETCO2, and BP along w/ RR. But a temp that high would be extremely suspcisios of sepsis


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## hops19 (Jul 11, 2014)

DEmedic said:


> Kind of pointless in SAR. If they're hot, cool them. If they're cold, warm them.



But how long do you cool them if they are suffering hyperthermia? Without a valid temperature you don't know when it is safe to transport...


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## MonkeyArrow (Jul 11, 2014)

hops19 said:


> But how long do you cool them if they are suffering hyperthermia? Without a valid temperature you don't know when it is safe to transport...



I'm sorry!?! I'm transporting them as soon as I can get to a rig. The temperature at the hospital will yield much better treatment than my thermometer in the middle of a campground somewhere.


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## hops19 (Jul 12, 2014)

MonkeyArrow said:


> I'm sorry!?! I'm transporting them as soon as I can get to a rig. The temperature at the hospital will yield much better treatment than my thermometer in the middle of a campground somewhere.



Body temp of >104 for greater than 30 minutes often results in fatality. Immediate cooling is necessary in whatever means possible. If you in a SAR-type situation, prep for heat stroke treatment on site needs to be in plans...


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## Outbac1 (Jul 12, 2014)

We have a Welch Allyn.   Braun 4000 thermoscan tympanic thermometer. It has both names on it. It seems to be reasonably accurate. We have no protocol that has a specific temp in it.
I consider the temps provided to be an approximation. + or - 2f (1c)  doesn't really mean a lot diagnosticly.


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## vcuemt (Jul 12, 2014)

hops19 said:


> Body temp of >104 for greater than 30 minutes often results in fatality.





hops19 said:


> treatment on site



ba-ba-bwah?


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## Underoath87 (Jul 13, 2014)

hops19 said:


> Body temp of >104 for greater than 30 minutes often results in fatality. Immediate cooling is necessary in whatever means possible. If you in a SAR-type situation, prep for heat stroke treatment on site needs to be in plans...



What sort of on-site treatment are you envisioning that couldn't be done in route? 
We're generally looking at exposure, ice packs, and air conditioning on a BLS unit (+ NS for ALS).


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## hops19 (Jul 13, 2014)

http://youtu.be/X1-g3dVVvaM


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## NomadicMedic (Jul 14, 2014)

What's your point? If they are HOT, cool them and get them to a hospital. If they are COLD, warm them and get them to a hospital. It doesn't take a rocket scientist to figure out... And in a SAR situation, it'll be basic measures a anyway. So, carry any thermometer you want, but it doesn't REALLY affect the care.


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## Household6 (Jul 14, 2014)

I have these "mom hands" with a calibrated temperature sensing.. After 20 years of rearing kids, I'm actually pretty damn good at estimating within .5 degrees..  The only time I really use them is during a febrile seizure call, or other ped calls.

The other temperature monitoring I use is a gastric monitor during cardiac cooling.


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## Brandon O (Jul 14, 2014)

hops19 said:


> Body temp of >104 for greater than 30 minutes often results in fatality.



Do you have a source for this?


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## OnceAnEMT (Jul 15, 2014)

Brandon O said:


> Do you have a source for this?



104 and is stroke territory, 106 is more fatality worthy. But as mentioned, this varies by person. These are AT guidelines. 

The protocols I work under require cooling to <102.2 before transport, so temps can certainly be in protocol if thermometers are on board. 

Fun fact, heat illness landmarks for K9s are about 2 degrees higher than humans. So normal around 100, stroke after 106ish. We are told to slow it down after 103 and stop at 105ish (varies by dog norm).


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## MonkeyArrow (Jul 15, 2014)

Grimes said:


> 104 and is stroke territory, 106 is more fatality worthy. But as mentioned, this varies by person. These are AT guidelines.
> 
> The protocols I work under require cooling to <102.2 before transport, so temps can certainly be in protocol if thermometers are on board.
> 
> Fun fact, heat illness landmarks for K9s are about 2 degrees higher than humans. So normal around 100, stroke after 106ish. We are told to slow it down after 103 and stop at 105ish (varies by dog norm).



What prevents you from transporting at 104? I guarantee you that whatever you can do on scene, a hospital can do much much better. Even if it's just cooling with ice packs, your ambulance has 5 ice packs, the hospital has an ice maker. You have an oral thermometer, they have a rectal thermometer.


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## vcuemt (Jul 15, 2014)

Grimes said:


> 104 and is stroke territory, 106 is more fatality worthy. But as mentioned, this varies by person. These are AT guidelines.
> 
> The protocols I work under require cooling to <102.2 before transport, so temps can certainly be in protocol if thermometers are on board.
> 
> Fun fact, heat illness landmarks for K9s are about 2 degrees higher than humans. So normal around 100, stroke after 106ish. We are told to slow it down after 103 and stop at 105ish (varies by dog norm).



I still don't understand what you mean by your protocols requiring you to cool prior to transport. So if you don't cool to under 102, you won't transport?

I just envision you sitting outside on a ball field throwing cooling pack after cooling pack onto a comatose kid and frantically checking your thermometer for it to dip under 102 so you can leave the scene.


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## Rialaigh (Jul 15, 2014)

DEmedic said:


> What's your point? If they are HOT, cool them and get them to a hospital. If they are COLD, warm them and get them to a hospital. It doesn't take a rocket scientist to figure out... And in a SAR situation, it'll be basic measures a anyway. *So, carry any thermometer you want, but it doesn't REALLY affect the care*.



This is the attitude many are trying to get away from in EMS though. I mean seriously I can think of 100 things we do that doesn't effect care at all and doesn't make one wee bit of difference in mortality or comfort. 

You can't be better at what you do without doing tons of useless :censored::censored::censored::censored:. Medicine has proven that over and over. If we want to move towards field treatment instead of meat wagon transport we are going to have to adapt to the hospital way of doing things.


We carry tempanic thermometers, and are in the process of getting esophageal probes for our new LP15's.


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## NomadicMedic (Jul 15, 2014)

What kind of treatment do you have in the field that would preclude transport? 

If they are hyperthermic, this is one of those cases where you cool them and transport them.

I standby my claim that, in this case, getting the patient to the hospital is a much better idea than sitting around and messing with haphazard cooling or rewarming efforts.


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## Carlos Danger (Jul 15, 2014)

Rialaigh said:


> This is the attitude many are trying to get away from in EMS though. I mean seriously I can think of 100 things we do that doesn't effect care at all and doesn't make one wee bit of difference in mortality or comfort.
> 
> You can't be better at what you do without doing tons of useless :censored::censored::censored::censored:. Medicine has proven that over and over. If we want to move towards field treatment instead of meat wagon transport we are going to have to adapt to the hospital way of doing things.



Interesting that you point this out when the hospital culture is trying hard to shift in the direction of NOT doing things that haven't been shown to improve outcomes. Even when things _have_ been shown to improve outcomes, their benefit needs to be weighed against the cost. "Progressive medicine" largely means doing more with less.

Some things just don't matter. Thermometers are one of those things.


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## Rialaigh (Jul 15, 2014)

Remi said:


> Interesting that you point this out when the hospital culture is trying hard to shift in the direction of NOT doing things that haven't been shown to improve outcomes. Even when things _have_ been shown to improve outcomes, their benefit needs to be weighed against the cost. "Progressive medicine" largely means doing more with less.
> 
> Some things just don't matter. Thermometers are one of those things.



Yet every patient in fast track at every hospital with some poison ivey or a swollen ankle will get their temp taken. 

I'm not arguing that the benefits probably don't outweigh the costs, I'm just saying given how little lobbying power EMS has the path of least resistance to doing more in the field and treating patients..moving towards referals and no transports..etc...is going to be hospital based systems where we are extensions of the ER. 

I'm just saying that thermometers are odd things for services to nitpick about, you have all those services carrying glucagon when their average transport time is 10 minutes to a hospital, they have IO's, D50, D5, and yet they spend thousands of dollars a year on glucagon and then complain about having to buy 60 thermometers for 15 ambulances...


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## OnceAnEMT (Jul 16, 2014)

Sorry for the confusion, I reread the section for hyperthermia (M10 in ATCEMS COGs) and it says to continue cooling if temp is over 102.2, but no mention of holding transport. Not sure where I heard that. I must have confused it with the AT side of things, where the ice bath trumps all in the field. 

In SAR, yes, we would extricate despite temp because there is nothing we can do besides water and fan.

The ED I am at takes quick care temps as well. I just tell the wrist Fx Pts that it is to help make sure nothing else is going on because of the injury. Usually suffices. Unfortunately since I have been there over the past few months there has not been any progression, other than efficiency improvements to our pt charting software.


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## joeyCC (Jul 16, 2014)

Your bus have air conditioning? 
You have hands to get temp?
You have a uniform on to keep warm?

If you have all three, roll. Don't you-know-what around with a kid's temp in his kitchen while his brain melts.


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## Akulahawk (Jul 16, 2014)

joeyCC said:


> Your bus have air conditioning?
> You have hands to get temp?
> You have a uniform on to keep warm?
> 
> If you have all three, roll. Don't you-know-what around with a kid's temp in his kitchen while his *brain melts.*


I have yet to see a brain melt. Sometimes it's a good idea to begin temperature stabilization on scene instead of getting the patient into an ambulance that may have marginal ability to heat/cool the patient compartment and certainly doesn't have the ability to easily manage the patient's temperature. Sometimes it makes sense to get the patient to a facility where it's easier to rewarm or cool.

If my patient feels too hot or cool, I'm going to get a temp right away. Will that temp reading (in isolation) change the care I give? No. The entirety of circumstances surrounding the patient can, though... and temp is one of the factors.


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## Handsome Robb (Jul 16, 2014)

I'm mellllllllllllllting!!!!!!!!!!!!

Severely hypothermic patients can be very susceptible to movement. Why not spend a little bit of timing getting them really packaged well and starting the rewarding process rather than run run run run?

Hyperthermia needs to be addressed as well, but you won't catch me going code with a hyperthermia patient when I have the ability to initiate cooling. There's a reason we're one of the last nations to advocate scooping and running. 

Watch "An Hour to Save Your Life" on YouTube. Yea it's doctors but they're sitting on scene taking care of the patients needs for much longer with much sicker patients than we are running to the hospital with. They're not doing anything crazy on most either. 

What's the rush?


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## TransportJockey (Jul 16, 2014)

joeyCC said:


> Your bus have air conditioning?
> You have hands to get temp?
> You have a uniform on to keep warm?
> 
> If you have all three, roll. Don't you-know-what around with a kid's temp in his kitchen while his brain melts.


My service advocates staying on scene to stabliize a medical patient, and even most trauma patients, before transport. We can do near everything our ER can except for scans and blood. Hell we usually stabilize and transport straight to the airport if the patient is that bad. There's a lot of things we can do prior to leaving scene.


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## hops19 (Jul 18, 2014)

Check out this website. Also the NATA will have new guidelines coming out soon.

http://ksi.uconn.edu

I'm pretty sure I already posted the video about why it was important to COOL first, transport second. In some states, it is now required that high schools have a cold tub ready in case of exertional heat stroke because it is critical to cool ASAP. Full body immersion is the BEST cooling mechanism. You can't do that in the back of an ambulance..

Also, realize that in an active individual, there are only two accurate mechanisms of reading core body temperature. Use of a ingestible thermometers or a rectal thermometer. Using an oral thermometer is not "good enough."


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## zmedic (Jul 20, 2014)

I think it would depend on what is already in place and (obviously) protocols. If you were working a marathon in August, they brought a guy to the first aid tent who looks like he is suffering heat stroke, and has altered mental status. Now I tell you his temperature is 107 rectally, what do you do? I'd say if there was an immersion tub ready to go, cooling right now takes priority over transport. If it's going to take 15 minutes to set it up, I'd rather someone start basic cooling methods (wetting and fanning, removing clothes, A/C) and transport. 

This is one of the few scenarios where the temp really matters. You tell me someone has a core temp of 101, I say start basic cooling and get moving. You tell me it's 106, I say they have to get cooled RIGHT NOW.


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## MonkeyArrow (Jul 20, 2014)

hops19 said:


> Check out this website. Also the NATA will have new guidelines coming out soon.
> 
> http://ksi.uconn.edu
> 
> ...



You're right. I can't immerse someone in a tub of ice water in the back of my bus. But I can guarantee that 99.9% of the hyperthermia calls I run, there won't be a tub of ice water waiting for me to use on scene, especially in the SAR context that we were talking about earlier. However, I can guarantee you that one way or another, there will be a tub of ice water/chilled saline/ice packs made available for the pt's use at the hospital.


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