Remeber343
Forum Lieutenant
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I agree, it seems strange that a box wouldn't have one. We have our in the box and in all of our aid bags. They come in handy. Our typical vitals consist of bp, hr, temp, chem, 4 lead.
Does anyone carry a thermometer on their bus?
- Thread starter NYMedic828
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We have one on every rig. I have yet to see it read accurately. I don't use it (excluding maybe hypothermia). If you're warmer than me then you probably have a fever. Doesn't change my treatment either way except to raise my level of suspicion for certain problems. We don't carry acetaminophen so I can't really do anything to help your fever if you have one. If you're cold then I'm going to treat that in the obvious ways.
We did have one crew buy their own temporal scanner. I haven't heard how that's working out for them yet.
We did have one crew buy their own temporal scanner. I haven't heard how that's working out for them yet.
jjesusfreak01
Forum Deputy Chief
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Wake keeps one in the jump bag, another in the cabinet, and they just installed a thermometer upgrade on the LP15s they use. Protocol requires it before administration of acetominophen for fever reduction.
bigdogems
Forum Lieutenant
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We have both oral and rectal (for hypothermia protocol) We are required to have one on every pt. But that is in part that we are going to be participating in some studies and need it as a standard
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Since you already clarified the whole bus vs ambulance thing, I didn't think it was necessary to clarify any further.
To make you happy, on our ambulances (AKA medical bus/taxi), we have oral, rectal, tympanic, and temporal thermometers.
truetiger
Forum Asst. Chief
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We have a thermometer in each rig and also have protocols for pediatric fever.
Sasha
Forum Chief
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We have little peel and stick color changing strips you put on their forehead.
Still not entirely sure how they work and they don't stick too well. I usually document temp as "cool" "warm" "wnl" "hot" "cold"
Still not entirely sure how they work and they don't stick too well. I usually document temp as "cool" "warm" "wnl" "hot" "cold"
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zmedic
Forum Captain
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Can you please list to me that things that having a thermometer will change in the field? Especially since if people are really sick the best temp is a rectal, which certainly isn't standard of care in EMS. Let me pre-empt some of your possible examples.
1. Pediatric fever- In most places medics can't give tylenol or Motrin, so what does it matter if the kid has a fever in the bus? If the kid feels hot open their blanket and help cool them down. If they seize you treat it, but febrile seizures aren't life threatening and my understanding is controlling with medications doesn't do much to prevent febrile seizures.
2. Sepsis. How will your treatment of a 75 year old nursing home patient with altered mental status change if they have a fever or not? Are you going to start antibiotics in the field? Are you going to draw blood cultures? Are you going to start fluids that you wouldn't be starting otherwise because they are tachycardic?
3. Enviromental- First of all you need special thermometers, ones that go above 104 and bellow 94. Secondly this again should be rectal. Thirdly how will this change management? Guy is running around in 100 degree weather. He had hot red skin, altered mental status. Does it change your management if his temp is 101 vs 104? Same goes for hypothermia. It might make some difference in the ER if the patient is 85F vs 93F, but in the ambulance you are going to turn up the heat, blankets, warm IVF.
I'd argue most of the time in the US the temp is going to distract you from other things you should be doing. To our friends in other countries, I aruge that you have a different system and different training. In the US I think if someone calls an ambulance they should be encourage to go the hospital generally. How hard you push should depend on how clearly it is shanagans. But I don't think a temp should sway you one way or another in most cases. 70 year old calls you for shortness of breath. Yes, if their temp is 101 I'm more worried about a pneumnoia. But if a 70 year old has trouble breathing an no temperature, they still should be in the ER. Conversly if a 35 year old calls because they feel sick, and they have normal vital signs (heart rate, mental status, blood pressure), I don't think that them having a temp of 104 pushes me to have them come to the hospital more than if they don't have a fever.
My issue is that more information is not always better. If someone wants to advocate for having any treatment or equipment on an ambulance I say great, tell me (ideally back by research) how it will improve safety, efficiency, or patient outcomes. Otherwise it is just increasing cost and distracting from other core tasks (repeat vital signs, finishing paperwork in a timely fashion, gathering additional history.)
1. Pediatric fever- In most places medics can't give tylenol or Motrin, so what does it matter if the kid has a fever in the bus? If the kid feels hot open their blanket and help cool them down. If they seize you treat it, but febrile seizures aren't life threatening and my understanding is controlling with medications doesn't do much to prevent febrile seizures.
2. Sepsis. How will your treatment of a 75 year old nursing home patient with altered mental status change if they have a fever or not? Are you going to start antibiotics in the field? Are you going to draw blood cultures? Are you going to start fluids that you wouldn't be starting otherwise because they are tachycardic?
3. Enviromental- First of all you need special thermometers, ones that go above 104 and bellow 94. Secondly this again should be rectal. Thirdly how will this change management? Guy is running around in 100 degree weather. He had hot red skin, altered mental status. Does it change your management if his temp is 101 vs 104? Same goes for hypothermia. It might make some difference in the ER if the patient is 85F vs 93F, but in the ambulance you are going to turn up the heat, blankets, warm IVF.
I'd argue most of the time in the US the temp is going to distract you from other things you should be doing. To our friends in other countries, I aruge that you have a different system and different training. In the US I think if someone calls an ambulance they should be encourage to go the hospital generally. How hard you push should depend on how clearly it is shanagans. But I don't think a temp should sway you one way or another in most cases. 70 year old calls you for shortness of breath. Yes, if their temp is 101 I'm more worried about a pneumnoia. But if a 70 year old has trouble breathing an no temperature, they still should be in the ER. Conversly if a 35 year old calls because they feel sick, and they have normal vital signs (heart rate, mental status, blood pressure), I don't think that them having a temp of 104 pushes me to have them come to the hospital more than if they don't have a fever.
My issue is that more information is not always better. If someone wants to advocate for having any treatment or equipment on an ambulance I say great, tell me (ideally back by research) how it will improve safety, efficiency, or patient outcomes. Otherwise it is just increasing cost and distracting from other core tasks (repeat vital signs, finishing paperwork in a timely fashion, gathering additional history.)
epipusher
Forum Asst. Chief
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Why would you need to carry a thermometer on a school bus?
Sasha
Forum Chief
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So you can keep sick kids home. All must have a normal temp before boarding the bus.
NO FEVER SHALL PASS.
Aidey
Community Leader Emeritus
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With more places having "sepsis alerts" I think that is where pre hospital temps are going to be the most useful. One of our hospitals is in the process of testing an in house alert, and one of the criteria is a temp under 97.4 or above 103 (I think those are the numbers).
zmedic
Forum Captain
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Again I think those temps should rectal, which I'm not sure is so fesible in the field. Also I'd like to see some data that a prehospital temp is going to reduce time to antibiotic administration. I think in most cases there should be signs of sepsis like tachycardia or altered mental status that would clue one in to the possible diagnosis. Also I wonder if people will be falsely reassure by a prehospital temp.
Now there may be a role for it in the field, but I want to see some good data before I'd recommend if for widespread usage.
Aidey
Community Leader Emeritus
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Sorry for the brief post before, I was on my phone. At this point the hospital is working on identifying patients who have possible sepsis, and then they are auditing the results to determine if having a sepsis alert is beneficial.
The hospital testing out the sepsis alert has a list of criteria the patient must meet. The pt has to have a suspected infection, and then at least 2 or more of 5* physiological criteria.
They are:
Temp greater than 100.4 or under 96.8
Heart rate above 90
Respirations above 20 or PaCo2 below 32mm/hg
Confusion/Delirium/AMS
high or low WBC count, either above 12,000 or below 4,000.
Right now, we can't measure temp or WBC count, leaving only 3 criteria, and they can all be easily affected by secondary causes throwing off the results. The patient may be on beta blockers or have a pacemaker that prevents their heart rate from rising. There are multiple respiratory diseases that could cause the PaCo2 to stay above 32 mm/hg. The patient may have underlying confusion/delirium/AMS.
So in the event they institute a sepsis alert program with these criteria we really need to be assessing temperature. I understand that rectal is the best, but the initial temps in the ER aren't rectal. If they get an abnormal reading they double check it rectally. So I think that given these circumstances it may justify checking temps pre-hospital.
*Well, 6 if you count respirations above 20 or PaCo2 as two separate criteria.
The hospital testing out the sepsis alert has a list of criteria the patient must meet. The pt has to have a suspected infection, and then at least 2 or more of 5* physiological criteria.
They are:
Temp greater than 100.4 or under 96.8
Heart rate above 90
Respirations above 20 or PaCo2 below 32mm/hg
Confusion/Delirium/AMS
high or low WBC count, either above 12,000 or below 4,000.
Right now, we can't measure temp or WBC count, leaving only 3 criteria, and they can all be easily affected by secondary causes throwing off the results. The patient may be on beta blockers or have a pacemaker that prevents their heart rate from rising. There are multiple respiratory diseases that could cause the PaCo2 to stay above 32 mm/hg. The patient may have underlying confusion/delirium/AMS.
So in the event they institute a sepsis alert program with these criteria we really need to be assessing temperature. I understand that rectal is the best, but the initial temps in the ER aren't rectal. If they get an abnormal reading they double check it rectally. So I think that given these circumstances it may justify checking temps pre-hospital.
*Well, 6 if you count respirations above 20 or PaCo2 as two separate criteria.
No no no, it really needs to be an esophageal temp...of course, that's easiest done when the patient is paralyzed and intubated so...tubes for everyone! Don't you see, it's the perfect solution; every patient will get an accurate temperature checked, and the number of intubations will skyrocket so high that every paramedic will be getting dozens of intubations yearly. It's a win win situation!
Or...I may have had to much to drink...:beerchug:
I think it's a worthwhile thing to be able to measure, moreso in patient's who ARE intubated (especially trauma and mandatory in patient's who are post arrest and getting therapeutic hypothermia), but, first off, an accurate way to check needs to be available, and many thermometers aren't.
The core temp is what needs to be known, and that can be...hard to gauge in some patients.
Once that's done, it won't neccasarily change treatement, but it would hopefully clue providers in that what they are doing/not doing is making the situation potentially worse.
Far as sepsis treatement goes...a fever or hypothermia isn't crucial to the diagnosis. While it may help some providers to determine what is going on, I'd hope that not having a specific body temp wouldn't dissuade someone from calling a patient septic when all other indicators pointed in that direction.
Except here, Australia, UK, maybe Canada
Alot of paracetamol is being given for low grade fever and treating it may not be in the best interest of the patient
Yes and yes
A septic patient can be hot or cold and may present subtly non specifically unwell so a temperature might swing your decision to leave them at home or not
Just because you can't do something doesnt mean the concept is a bad idea