Checking temp 'to touch.' What part of your hand do you use?

[Chief1C]

Who's your instructor? Capt. Morgan? I hung out with Capt. Morgan most of the night, so long that I didn't wake up till almost 1430.

http://www.mooremedical.com/index.cfm?PG=CTL&CS=HOM&FN=ProductDetail&PID=14911

[tniuqs]

Yup Comrade Morgan and Comrade Clapton a great mix.

Sorry 2c4 im going to use the 2c4 cm anal probe ... just to be certain you know. ROFLMFAO ... I slay me.

Just a "bit of pressure" my ICU RNs would say .

cheers

[Bernhard]

I think the point of this is for folks who do not use thermometers prehospitally to come up with best way to determine if a patient may be febrile WITHOUT the use of a thermometer. We don't use them in our system, nor do many folks, so I think these tips are a good idea."

Pardon, but a real thermometer should be part of the equipment in an ambulance. Even a cheap electronic one is better than nothing or using subjective "feelings" to determine a treatment plan. A professional licensed device with hypothermal temperature range would be preferable, though (still searching...).

Yes, I use my hand (palm/wrist/backside, no real preference) to get a feeling, but it's just before taking a more objective temp if suspicious. I rather would like to be able to take temp on every patient, if our thermometers would be faster (we don't use IR devices yet).

In a remote setting, where every weight and space counts, it may be not so easy to carry an additional device. But a simple thermometer isn't the real problem even there, I would think. No experience, though.

I don't trust my own feelings much when it comes to determine exact values, they may do for some indicators, but not much more. For real measurements I want to be equipped. And body temperature sure is a thing a health care provider should have in his view.

I don't know if 9Orange's intent was to be arrogant but I am pretty sure it was a disparaging remark against the other posters that do use alternative non technological measures to measure temperature.

In my view he made a very valuable point. I myself recently made a disparaging remark in another thread against someone who pretends to get accurate blood pressure by manual feeling.

The intend of this thread still is valid and interesting: IF using the hand, how to use it? I'm sure Dwayne is aware that a thermometer can be used and should be for accurate measurements. I try to get a feeling for blood pressure by manual pulse check, too - but then measure it with a sphygmomanometer.

He is almost implying that they run around killing chickens and breaking eggs on people’s heads to heal their illness that are other voodoo practices.

I rather would use a thermometer. On the long term it would be cheaper, the storage in the ambulance is easier, even transport to remote settings would be more practical and you can use it not only on full moon. It doesn't taste as good like a fried chicken and egg, though (but that may be covered in the thread about food rations on shift).

[DwayneEMTP]

Benhard, as always I respect your opinion, but could you do me a favor? Along with this opinion can you answer the questions that I posed to 9OrangeLetters?

I'm curious as to your thoughts.

Dwayne

[Richard B the EMT]

I think that we check the temperature by pulling our glove down and using the back of out hand because that is what the AAOS EMERGENCY Care and Transportation of the Sick and Injured Tenth Edition states as part of the Primary Patient Assessment. If it is still in the Tenth edition I could be reasonably sure that it had been included in the prior editions as well.

The text reads:

”Body temperature is usually measured with a thermometer in a hospital. However, in the field, feeling the patient’s forehead with the back of your hand is usually adequate to determine whether the patient’s temperature is elevated or decreased”

AAOS EMERGENCY Care and Transportation of the Sick and Injured Tenth Edition states in Chapter 8, page 273

I actually recall seeing much the same passage in the FIRST edition of the "Orange" textbook (yeah, I've been around THAT long in the field).

Apparently, using one's lips to check your pt's temp is frowned upon. Who knew?

I'd take a guess that it is only approved for use on spouses and offspring, with possible use with one's own parents.

PS I would really like to bitch slap that Jenny McCarthy myself.

Did I miss something? Where did that come from?

Some services use disposable "Temp-A-Dot" type thermometers, but not all do. Besides, would any of youse guyz put something like an oral thermometer in the mouth of an unconcious patient? Rectal thermometers are obviously more than a bit invasive, but try using one of them on an open street scene before moving the patient into the ambulance.

Open question: With the theme of "if it's wet, if it's sticky, and it ain't yours, don't touch it" being the reminder of why we wear gloves, why would we lower our protection by pulling the glove back from either the inner wrist or back of the hand to make contact with the patient?

[tcripp]

I'd take a guess that it is only approved for use on spouses and offspring, with possible use with one's own parents.

I guess it depends on how cute your patient is...

[Richard B the EMT]

I guess it depends on how cute your patient is...

Uhhh, best not go there, with all it's potential trouble!

[tcripp]

Please, every one...there was sarcasm in those posts. Just want to make sure we are all on the same page here...

[Richard B the EMT]

Is there a smileyface to indicate dripping sarcasm?

[Bernhard]

Benhard, as always I respect your opinion, but could you do me a favor? Along with this opinion can you answer the questions that I posed to 9OrangeLetters?

I tried to avoid it, because I had troubles with the Fahrenheit unit you used AND I have no experience with wilderness or military EMS. I'll do my best, including some spelling and grammar errors just for you.

Exactly why the question was regarding whether or not those methods were based in logic or just urban legend passed down from grandmothers.

I can't answer this. I didn't learn it in EMS school, I learned it from my mother.

Personally I have no preference how to feel a temperature and constantly am unsure if it is worth anything. I do it anyway, but wouldn't rely on my manual measurement and would like to use a thermometer. So I really appreciate this discussion.

You would expect all of that in a pt that's 99.5F? As they are hyperthermic, right?

That's specific to 9Orangeletters, I wouldn't expect the descripted symptoms at 37,5°C (=99,5°F) coming from the temperature alone. But I didn't read his description as absolute signs of a slight hyperthermia, instead as signs of a relevant hyperthermia.

Are you not interested in localized hyper/hypothermia then? How does your tympanic thermometer work when assessing cellulitis without global hyperthermia? My guess would be not very well. How about the soldier with numb toes who's CO needs to know if it's ok for him to continue in the field or needs to be removed?

I don't think the usual thermometers are worth measuring local temperature, but it would be worth a try (experiment time again!). The other question is: do I need it? In normal stupid middle-european climatic civilisation-near ambulance based EMS work those are things we either don't see or we don't spend much time caring on the street. If vital challenged or otherwise worth to see a doctor, both cases would be transported without further diagnosing of localized inflammation or frostbite but caring for general vital condition.

So I can only throw in two suggestions:

1. There are systems for local temperature measurements. Maybe even your smartphone has an App for it.
   
2. It's far easier (even for me) to compare temperatures between two parts of the same body than to determine a general body temperature. So maybe even I would be able to feel a local temperature difference. I wouldn't be able to quantify it, though.
   

The question stays: do we need to quantify localized temperatures anyhow? I really don't know what the result or treatment choices would be for different degrees in temperature of cellulitis or frosty toes...but I would be glad to hear how this is a base for a treatment/evacuation decision in wilderness/military settings.

Is it then still voodoo to assess temp to touch?

If you come up with a certain temperature value: yes. My old house physician (may God rest his soul) always did this to me, telling my fever temperature exactly by a hand shake. So, this voodoo seems to work. But I don't know how - and he always proved it afterwards with a thermometer anyway.

Fair enough. Let's say that you have the above hyperthermic patient, what treatment alterations are you going to make based on a digital number on your thermometer? Will you choose not to actively cool this patient if the thermometer reads 99F?

Yes, I would do nothing against high temperature because it is not the problem then (99°F = 37,2°C).

Would you choose to run emergent to the ER if your thermometer reads 106F yet your patient is cool to touch globally?

Such a core temperature (106°F = 41,1°C) surely indicates high fever and if any condition allows the skin to be globally cold, I would treat the fever anyway. Skin could be cold on touch due to exposure to environment or simply because my touching hand is too warm in comparision - or, as I always suspect, my sensoric feelings are totally unreliable.

How about if you have the exact patient above...what will be your different treatment plans be if your thermometer says 99F, 101F, 103F? How will you treat each of those patients differently?

Before answering this, let me explain that 9Orangeletters expected accuracy range of +/- 5° would be inacceptable for me. I have a six year old test survey of non-professional thermometers, it gives an accuracy of not much more than -1°C for the most products, if in laboratory calibration test or in situ. BTW, the mercury thermometer had the best precision...

So, the answer would be:

99°F = 37,2°C: no fever treatment, search for other cause

101°F = 38,3°C: fever treatment depends - a child with fast raising temperature will get some antipyretics soon.

103°F = 39,4°C: see 101°F, antipyretic treatments considered for adult as well.

Fever treatment includes wet packings and drugs, it depends a lot on rate of temperature raise and other findings (i.e. seizures?!). The underlying cause (infection?) has to be found as well (hospital lab?). The given general symptoms (altered mental status!) would suggest a transport to hospital anyway, if raised temperature or not. In my opinion, preclinical antipyretic activity would depend on temperature, yes, see above, if that's the core of your question. And I would like to base that on a more objective finding than just a touch of my unreliable hand.

So, I agree with 9Orangeletters here when he states (quoted from his posting): "Maybe a good idea to get a general tenor of the patient's temperature by using the back of your hand, inside of your wrist or your fingers/palm, but I wouldn't go basing any patient treatments off of voodoo, no matter how you do that voodoo so well..." - with "voodoo" in a more funny and non-offending sense than others may see it here.