Assuming room temperature

[Veneficus]

As I sit here staring towards the window and the snowy cold outside pondering the effects of hypothermia on the protein structure of coagulation proteins and clotting factors, I wonder...

Does anyone ever use one of those digital thermometers on arrest patients?

It seems like at the very least it would rule out hypothermia.

But the most important information it would tell you is how long the person has been laying there.

Which may be useful in determining whether or not to start resuscitaion.

"A person is not dead until they are warm and dead."

However, in the geriatric population, their high level of heat transfer affects compensatory metabolic processes. So while we generally consider hypothermia in temperatures of 35C or lower, in the elderly population, it might actually be a factor of decompensation at a higher temperature.

Temperature is a vital sign.

Just something to ponder.

 

[NYMedic828]

As I sit here staring towards the window and the snowy cold outside pondering the effects of hypothermia on the protein structure of coagulation proteins and clotting factors, I wonder...

Does anyone ever use one of those digital thermometers on arrest patients?

It seems like at the very least it would rule out hypothermia.

But the most important information it would tell you is how long the person has been laying there.

Which may be useful in determining whether or not to start resuscitaion.

"A person is not dead until they are warm and dead."

However, in the geriatric population, their high level of heat transfer affects compensatory metabolic processes. So while we generally consider hypothermia in temperatures of 35C or lower, in the elderly population, it might actually be a factor of decompensation at a higher temperature.

Temperature is a vital sign.

Just something to ponder.

This is definitely more of an advanced discussion.

Here in NYC we utilize esophageal temperature probes that plug into the phillips MRX monitor for any medical related arrest.

If the body temperature is above 32.5C we begin cold fluid infusion up to 2 liters unless pulmonary edema is present.

Also, never forget the old saying "they aren't dead until they are warm and dead"

If a patient is found outside in arrest, in an environment below that of normal body temperature than they will almost definitely be in a hypothermic state whether it was the actual cause of arrest or not. Once blood flow stops, hypothermia sets in very quickly. An arrest caused by hypothermia technically gives you a significantly increased chance of achieving ROSC with significant retention of neurological function.

 

[Aidey]

We only carry hypothermic thermometers, and they only go up to about 74 degrees F, so the short answer is no.

I used to work in an area that used "No one is dead until they are warm and dead unless they are under 60 degrees F". I have obtained a rectal temp to determine if we were above or below the 60 degree cut off.

 

[Veneficus]

I know my typing and spelling sucks, but sometimes I really don't think I am speaking the same language when I read some of the replies to the stuff I post.

 

[STXmedic]

I hear what you're saying, and it makes sense. But my question is, how long does it take the human body to "assume room temperature" post arrest? What's the heat transfer rate out of the human body (yes, I realize the current environmental temp plays a large role)? I've worked more than my share of full arrests, but honestly haven't really considered getting a temp outside of an environmental hypothermia...

I think temp is a good vital to correlate with other findings, such as asystole, to confirm death. However, I don't think it should be used as your primary indicator (not that that's what you're inferring). I can just picture a BLS unit showing up on scene to a bradycardic pt and attempting to "call it" because they're cyanotic with a temporal reading of 95. h34r:

 

[bigbaldguy]

It's in our protocols to get rectal temp on any DOA. That said I don't think we do it on working arrests as a general rule. We do have to get a rectal if we discontinue and call it though.

 

[Veneficus]

I hear what you're saying, and it makes sense. But my question is, how long does it take the human body to "assume room temperature" post arrest? What's the heat transfer rate out of the human body (yes, I realize the current environmental temp plays a large role)? I've worked more than my share of full arrests, but honestly haven't really considered getting a temp outside of an environmental hypothermia...

I think temp is a good vital to correlate with other findings, such as asystole, to confirm death. However, I don't think it should be used as your primary indicator (not that that's what you're inferring). I can just picture a BLS unit showing up on scene to a bradycardic pt and attempting to "call it" because they're cyanotic with a temporal reading of 95. h34r:

I was thinking of temp. as part of standard vital signs, to be considered with other findings in a complete picture.

The second part was really about the possible need to treat hypothermia in the elderly population when the standard quantitative measurements were not met.

resuscitation is not limited to dead people. It is defined as the return of physiological function.

 

[Tigger]

I'm still waiting for a good explanation on why EMS does not take temperatures. Every other branch of medicine treats it the same as a BP or pulse. Why are we different?

When one of my athletes gets sick, one of the first things I do is take his temp. It's not going to tell me what's wrong with him, but that combined with the rest of my assessment can help get me pointed in the right direction. If one of EMS's goals is to rapidly paint an accurate and detailed picture of the patients condition, we should be taking temps. A temporal or tyampanic thermometer should be on every truck.

 

[abckidsmom]

Temporal and tympanic thermometers are wildly inaccurate.

I check the oral temp of most of my patients, and have become a real whiz at finding a UTI where one was not suspected. Most of my coworkers, if I was to say "we're running low on probe covers" reply that it doesn't matter because I am the only one that uses them. I recently took a 10 day vacation and came back to find that thermometers batteries were dead just like I left them.

People just don't want to take any extra steps that aren't mandatory. As a profession, we are real underachievers. Almost all of us, really, could be doing something much more significant with our time. And the rest really strike me as not too bright.

/sweeping generalization from a rough day, but I think it's got some merit.

 

[TheGodfather]

Temporal and tympanic thermometers are wildly inaccurate.

--------------------

"Core body temperature can be measured in the rectum, the esophagus, the tympanic membrane, or the bloodstream. Rectal thermometers provide the least reliable measurement of core body temperature"

Sources:

1) Gordan AS: Cerebral blood flow and temperature during deep hypothermia for cardiac surgery, J Cardiovasc Surg 3:299, 1962

2)ASTNA Patient Transport, Principles & Practice Fourth Edition, page 528; paragraph 1; line 7.

 

[abckidsmom]

--------------------



Sources:

1) Gordan AS: Cerebral blood flow and temperature during deep hypothermia for cardiac surgery, J Cardiovasc Surg 3:299, 1962

2)ASTNA Patient Transport, Principles & Practice Fourth Edition, page 528; paragraph 1; line 7.

Stand at a bedside with a temporal thermometer, use it correctly, and you can get wildly differing results. There is just too much randomness.

Studies might show that blood temperature is most regulated there but the means for measuring temporal temperature is not reliable.

 

[Ewok Jerky]

We don't carry thermometers

 

[TheGodfather]

Stand at a bedside with a temporal thermometer, use it correctly, and you can get wildly differing results. There is just too much randomness.

Studies might show that blood temperature is most regulated there but the means for measuring temporal temperature is not reliable.

i don't disagree with you on that! Tympanic, however, are more accurate in the severe/profound hypothermic arrest patient (due to results of rectal temps being affected by cold legs and vasoconstriction to that particular area)

 

[abckidsmom]

That makes sense, I just hate using a device to make clinical decisions where best practice is to take 3 and go for the average. Get me a swan, we'll use the temp on that for complete accuracy.

 

[TheGodfather]

That makes sense, I just hate using a device to make clinical decisions where best practice is to take 3 and go for the average. Get me a swan, we'll use the temp on that for complete accuracy.

:beerchug: if only......

 

[Veneficus]

That makes sense, I just hate using a device to make clinical decisions where best practice is to take 3 and go for the average. Get me a swan, we'll use the temp on that for complete accuracy.

One of the largest failures of medicine today is always basing clinical decisions only on of numeric parameters.

If you have no temperature elevation, but have symptoms, then you should treat for your suspected Dx.

It would be no different than having a patient that had a WBC count within normal limits but was caughing, sneezing, etc.

In sepsis particularly, temperature may not be elevated. BUt if you still had other symptoms or clinical suspicion, I have no doubt you would treat it. The same with UTI

There are a host of quantitative numbers and tables in medicine. MOre than I care to even try to remember. They were designed to help guide clinical judgement. They were never meant to replace it. (unfortunately they have)

I encourage all to be an outstanding provider and not get sucked into the trap of these number games.

As I stated in my original post, mostly because I was pondering the possibility, and do not know. If you had a 90 year old lady, is it possible she was suffering from the effects of mild (even moderate) hypotherma at lrt's say 72F?

Everyone who has been in healthcare for a while know older people keep temperature cranked to 80F+ on a regular basis because of their increased physiologic heat exchange.

If you walked into a room that was a comfortable temperature to you, it stands to reason an elderly person with a nonspecific complaint, might actually be suffering from mild hypothermia.

Which as I also mused inhibits things like clotting factors.

From just my thoughts on the matter, it might be prudent to remember warm elderly patients as part of treatment even in the nonacute setting of hypothermia as dictated by quantitative measure.

If you encountered a pt that had a nornmal temperature, but they were shivering, would you not consider that as compensating, the same way we would consider a normal range of BP but tachycardic compensationg?

Also of note for those buying their own stuff. The acceptable manufactured deviations in home use equipment are different than in "healthcare grade" devices.

Keep that in mind when using them to base decisions from.

(I am not saying "don't use them" I am of the mind something is better than nothing, just be aware of the limits of your equipment.)

 

[TheGodfather]

If you encountered a pt that had a nornmal temperature, but they were shivering, would you not consider that as compensating, the same way we would consider a normal range of BP but tachycardic compensationg?

Had an elderly end-stage cancer patient (if my memory serves me correctly, approximately mid-80s) who we transported for "psych" reasons from home.

Family got upset because she soiled herself, and the house became smelly. naturally they opened all the windows in the house (this was in december). patient was wearing a backless hospital gown. i was shivering inside the house (and i was wearing seasonal appropriate clothes)..

long story short, patient's oral temp read 97F on our junky digital thermometer. patient was not shivering, but she claimed to be cold. could she have progressed beyond 90F? sure. for that reason, we treated for hypothermia (passively; high heat, blankets, "warmed" fluids).