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Thanks Jim,
That is what I have been doing for  years. If a baby seemed hot from
bundling, or riding in a hot car, etc, I observe. Even though I have seen
people preach to the contrary, my observation has been that it is not
necessary to aggressively work up every babe with a temp of 38. 
A little common sense seems more appropriate. 

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: Chamberlain, Jim [mailto:[log in to unmask]] 
Sent: Thursday, February 14, 2008 8:06 AM
To: Martin Herman; [log in to unmask]
Subject: RE: Tympanic temps

Well, looking at the article about bundling infants (which said a single
isolated "fever" was OK as long as it went away with unbundling), I go
with clinical assessment plus a repeat temperature > 38.

To summarize:

One elevated temp plus otherwise well-->observe for X hours of repeated
temperatures (X depends on family/PCP situation)
Two elevated temps or some other sign of illness-->sepsis workup

I have no evidence for this, only clinical experience...

Jim

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 Martin Herman
Sent: Thursday, February 14, 2008 12:30 AM
To: [log in to unmask]
Subject: Re: Tympanic temps

Jim,
 I like what I am hearing. Especially admitting to a OBS or Clinical
Decision Unit for observation and serial temps. Just curious at what
point
do you intervene with cultures of urine, blood or CSF? Do you base that
entirely on your clinical assessment? IS there a temperature ( method is
not
the issue now) at which you would routinely culture an infant? Does age
make
a difference. Say 0-29 days versus 30-90 days? 

Looking for enlightenment.
 
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: Wednesday, February 13, 2008 10:58 AM
To: [log in to unmask]
Subject: Re: Tympanic temps

I admit them to our Observation Unit for serial temperatures (q 2 h), no
testing unless they get sicker...

Jim

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 Foltin, George
Sent: Wednesday, February 13, 2008 7:56 AM
To: [log in to unmask]
Subject: Re: Tympanic temps

So now we come to the well appearing two week old with a 100.5 or 100.4
temp. So precise but so inaccurate.


George L. Foltin, MD, FAAP, FACEP
Director, Center for Pediatric Emergency Medicine
Bellevue Hospital and NYU Medical Centers

Associate Professor of Pediatrics and Emergency Medicine
New York University School of Medicine

(O) 212 562-3161
(F) 212 562 -7752
(Cell) 917 842-5428
[log in to unmask]

----- Original Message -----
From: Pediatric Emergency Medicine Discussion List
<[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Sent: Wed Feb 13 00:31:30 2008
Subject: Re: Tympanic temps

We published norms on infrared ear temperatures in Annals of Emergency
Medicine circa 1995. I would use those.

The rectal site was chosen arbitrarily in the late 1800s. The thought at
the time was that it was a core body temperature. We now know that blood
supply is poor to the colon and stool has an insulating effect, thus
damping any changes.

For any who believe rectal temperature is accurate, there was a paper
out of Israel in mid 1990s that showed that rectal temperature varied by
up to 1 deg C, depending on depth of insertion.

As far as a valid test to detect illness, temperature doesn't come close
to anything we would normally accept for test performance. Sensitivity
and specificity are both poor.

So, why torture a kid and touch stool when the test is inaccurate
anyway?

Jim Chamberlain
Washington, DC

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List on behalf of Peter
Auerbach
Sent: Tue 2/12/2008 9:06 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
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