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Not to prolong this any more,
but wasn't the original question about whether we should be using
RECTAL temperatures or not?

I noticed you both wrote "38" ... 
so whether it's axillary, oral, tympanic, temporal, rectal or other makes no difference 
in a neonate as long as whatever device employed reads "38"?

Peter Auerbach



> Date: Thu, 14 Feb 2008 08:39:06 -0600
> From: [log in to unmask]
> Subject: febrile infants
> To: [log in to unmask]
> 
> 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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