To say that, since tympanics only give false negatives, they can be used in
cases where erroneous readings won't affect your treatment, then in those
cases why bother getting a temp at all? Will getting a wrong reading in a
child with a broken finger change your management? If not, then why bother
getting a temp at all in traumatic injuries?
For that matter, since the patient with a broken finger shouldn't have
respiratory involvement, why document a respiratory rate? Ancillary findings
of temps in children who present to the ED for other problems is a not
uncommon occurrence. It concerns me the thought of settling for potentially
inaccurate vital signs in the ED. When following trends on the floor, after
baselines have been established, is a debate for another day. But upon
presentation to the ED it is essential to obtain accurate vital signs and
assessments, including temps, for all patients.
As for the concept of not needing to know the degree of febrility, only its
existence, is IMHO erroneous. A 5wk old child with a temp of 37.8 may not
need a septic work up, but the same child with a temp of 38.3 surely will.
Fevers of 39.8 and 41.0 are triaged differently and are treated differently.
Anecdotally, at least, the rectal temp is the Gold Standard in children
Steven Taylor, RN, CEN
Children's Hospital of Philadelphia
----- Original Message -----
From: "Michael Shuster &/or Shelley Mardiros" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, December 29, 1999 9:58 PM
Subject: Re: How do you take temperatures?
> Dr. Graham:
> If, as you say, "minor differences in temp measurement are not clinically
> but the detection of whether or not fever is present is important" and if
> tympanic temps sometimes give false negative readings (even anecdotally)
> doesn't give false positive readings ( has anyone described false
> with tympanic temps?), then why not use tympanic temps for all patients
> reserve rectal or oral temps for those who have negative tympanic temps
> whom an erroneous negative reading will "make a difference in the decision
> making process"?
> Michael Shuster, MD, FRCPC
> Emergency Medicine
> Mineral Springs Hospital
> Box 1050
> Banff, Alberta
> Canada T0L 0C0
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