Print

Print


Peter has culled out the most poignant aspect. 

That is if we change the measures by which the medical community established
guidelines, how will we ever be able to apply the evidence that has been
accumulated over the past years of studies on febrile infants? 

I think rectal temps are still the best way to detect low grade fevers. I
don't think they should be done in triage especially if the child is exposed
to the entire waiting room. That strikes me as humiliating for the child and
just because they can't verbalize it, it is another way adults minimalist a
child's rights to privacy and control over their own bodies. 

If other less intrusive methods yield a temperature thought to represent a
fever, great! However I think confirmation in the privacy of an exam room is
warranted. If there is a high index of suspicion but the alternative methods
failed to detect, rectal confirmation is again warranted. For the multitude
of kids who are suspected of having had a fever but in whom the temp is
normal via some non invasive method and or who are acting normally, nothing
further should be necessary. Seems to me the sick ones "bubble" up if left
alone. 

Just my 2 cents,

Marty


------------------------------------
Pediatric Emergency Specialists, P.C.
Martin Herman, M.D.,FAAP,FACEP
President
[log in to unmask]
PO box 637
Ellendale TN 38029
tel: 901 405 1407
fax: 901 405 1524
mobile: 901 219 9202 
------------------------------------

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Peter Auerbach
Sent: Tuesday, February 12, 2008 8:06 PM
To: [log in to unmask]
Subject: Re: Tympanic temps

Thanks for making this point,
with which I agree completely.
It's not that a rectal temp is as "accurate" as a "core body temperture" (as
if that matters anyway),
it's that a rectal temperature is what has been used the most by the medical
community to come up with arbitrary fever standards to help guide
decision-making.
If we all decide to use some other type of temperature measurement in very
young infants, fine, but what are the chances that everyone's going to agree
on that?!



> Date: Tue, 12 Feb 2008 19:34:52 -0600
> From: [log in to unmask]
> Subject: Re: Tympanic temps
> To: [log in to unmask]
> 
> Isn't the rectal temp the "gold standard"?  I mean isn't it the next best
to
> core temperature that we can access? I realize that core temp is the body
> temp when measured via an indwelling probe and that the next best
surrogate
> is  an esophageal probe but really isn't the rectal temp what the entire
> medical community has used for decades to decide who is sick and who
isn't? 
> 
> 
> Marty
> 
> 
> ------------------------------------
> Pediatric Emergency Specialists, P.C.
> Martin Herman, M.D.,FAAP,FACEP
> President
> [log in to unmask]
> PO box 637
> Ellendale TN 38029
> tel: 901 405 1407
> fax: 901 405 1524
> mobile: 901 219 9202 
> ------------------------------------
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List
> [mailto:[log in to unmask]] On Behalf Of Chamberlain, Jim
> Sent: Tuesday, February 12, 2008 4:19 PM
> To: [log in to unmask]
> Subject: Re: Tympanic temps
> 
> Rectal temperature is inaccurate compared to core body temperature. When
> temperature is changing (as in febrile conditions), rectal lags behind
> other sites (esophageal, oral, tympanic, and infrared ear thermometer)
> by 20-30 minutes.
> 
> Rectal temperature is also non-hygienic.
> 
> James Chamberlain, MD
> Division Chief, Emergency Medicine
> Children's National Medical Center
> Washington, DC
> 202.476.3253 Office
> 202.476.3573 Fax
> 202.476.5433 Emergency Access
>  
> 
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List
> [mailto:[log in to unmask]] On Behalf Of Julia Whitefield
> Sent: Tuesday, February 12, 2008 1:37 AM
> To: [log in to unmask]
> Subject: Tympanic temps
> 
> Dear all, I am finally breaking down... while in favor of rectal temps
> in < 36 months old... I don't feel like having to re-invent the wheel:
> who of you do tympanic temps in your ED - do you have good literature
> support? - and how many of you are in support of rectal temps? I thought
> we had cleared that issue for once and for all - but I guess not! Would
> you please give me your input?
> Thank you so
> Julia S. Whitefield MD, Ph.D.
> UNM
> ABQ, NM
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
> 
> Confidentiality Notice: This e-mail message, including any attachments, is
> for the sole use of the intended 
> recipient(s) and may contain confidential and privileged information. Any
> unauthorized review, use, disclosure or distribution is prohibited. 
> If you are not the intended recipient, please contact the sender by reply
> e-mail and destroy all copies of the original message.
> 
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
> 
> For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html