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Jim--Once in your OBS Unit, what temperature, if any, triggers testing; what observation signs and symptoms lead you to perform testing?
 
Bob> Date: Wed, 13 Feb 2008 11:57:37 -0500> From: [log in to unmask]> Subject: Re: Tympanic temps> To: [log in to unmask]> > 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> > 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> 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> > ------------------------------------------------------------> This email message, including any attachments, is for the sole use of> the intended recipient(s) and may contain information that is> proprietary, confidential, and exempt from disclosure under applicable> law. Any unauthorized review, use, disclosure, or distribution is> prohibited. If you have received this email in error please notify the> sender by return email and delete the original message. Please note, the> recipient should check this email and any attachments for the presence> of viruses. The organization accepts no liability for any damage caused> by any virus transmitted by this email.> =================================> > 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. 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