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Trach

Best Method To Take A Temperature - Need Advice Asap

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Dear All,

One of our members has a daughter with dysautonomia and EDS. Her daughter is very ill and recently had a central line put in for TPN. The line got infected.

We need your help. The children's hospital has been very good at addressing the infection. Line is out. Except the mom has always had to take her daughter's temp with an ear thermometer. A mouth thermometer rarely shows a temp. Her daughter is now showing a large spike again by the ear thermometer but the hospital refuses to go by the ear thermometer. The hospital insists on using the oral thermometer. Oral is 97 ear is 103.

Can anyone help with articles supporting ear thermometer?

Thanks,

Trish

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I have to chart my temp (for something unrelated to POTS) for 2 years. It was for a study at Yale. Ill try and find my report. I found underarm readings to be the most accurate. I have a themometer with underarm conversion, if not remember to add 1.5 degree to a normal themometer. Oral was the least accurate and the ear method was not accurate because my canal is slightly off and unless it is positioned correctly reads off.

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Not sure what's most accurate, but does the daughter feel warm to the touch? I would think the mom (if healthy) could detect such a 103 fever just by feeling her forehead. Also is she experiencing other symptoms chills, sweating, etc.?

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Thank- you for your replies. The on call docs decided to defer the issue to infectious disease. The mom is using the ear thermometer that the hospital used to use until a few years ago and the same one her PCP still uses.

The docs did acknowledge her daughter was hot to the touch, had chills, and was flushing. Mom is not comfortable putting a central line back in until the fever is gone (looks like MRSA). The problem is there isn't a fever under the hospital method, but there clearly is a fever when taken by ear and by observation.

I cannot find any articles that support which method to use for dysautonomia patients. Hopefully infectious disease docs will clearly observe the patient and see she is in distress.

Thanks again for the advice!

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Different parts of the body are at a different temperature, so the same number will be a fever for one area but not for another. I think Wikipedia explains this thoroughly, with numbers.

I'm not sure how accurate ear thermometers are. They're popular because they're convenient. Mind you, hospitals use them, but I've found hospitals to be very inconsistent on what they consider to be a fever.

I hope the girl's doing better now.

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Hi,

Thanks for the replies everyone. Trach posted this question for me as we were still in ICU and no time to get online. My daughter was admitted to ICU with a central line infection, and was presenting with high heart rate, low bp, extreme tremulousness and high fever, as well as the extreme nausea, headaches and swelling pain she has been dealing with for weeks. Unfortunately, the hospital protocol is oral or axillary (under arm), and neither of these have ever been a consistently accurate for her.

Given the state of her health over the last couple of years, we do "vitals" almost daily, and have a very good idea of her baseline temp, via tympanic (Ear). (We are also careful to take it properly straightening the ear canal and making sure it is placed in the ear properly). A couple of times a week, we will take oral as well, and it correlates (with proper adjustment to scale), most of the time when no fever is present. However, when she starts to present with fever (and its symptoms), oral never seems to capture the fever for her. So, we have a temp history for her based on ear.

When she went into the ER last week, it was obvious, without any type of temp check, that she was having fever (very hot to touch, flushed, hot/cold, aches). We knew she was as well, because, instead of her usual 99.1-99.3 baseline, she was 103.6. But, oral in ER showed 98.7. One look at her, and one touch to her face, and that was obviously wrong, but they chose not to go with our ear reading, and instead to go with no fever per oral. Due to the high heart rate (145-150) and the low bp, and the positive culture from her line, they started IV fluids to bring the heart rate down. One hour and 2L later, though quite swollen, her heart rate was still soaring and she was burning up. They showed a temp of 99.7, we showed 104.3. She was a far cry from 99.7.By this point, she was in septic shock, and they had to transfer her to the main campus of the hospital via ambulance. Upon arrival at main campus, she was burning up. Again, they chose to go with oral, and showed she was 98.7. Ear showed 103.5. Five minutes later, they moved her to ICU, the nurse took one look at her and said there's no way she's 98.7. We once again explained that the most accurate read on her temp is via tympanic, but due to protocol, they couldn't use it. They did immediately take it via axillary and got 103.3.That helped. But axillary turned out to be accurate about 50% of time as well. We've since learned that axillary can lag behind core temp by up to three hours.

What we are trying to understand is this - is there a correlation between autonomic issues and accurate ways to measure body temps for those with Dysautonomia? I know we are all different, but wondering if anyone has run into this. My sister and I also both have Dys / POTS, and our ear temp has always been more accurate than oral, if we do nothing more than compare it to the symptoms we are having. Axillary is not consistent for us either.

We have since found an article from the NIH that discusses the accuracy of temp taking methods, and favors rectal as the gold standard, but tympanic as the next most accurate, if taken properly. Axillary is considered the least reliable.

We are still in-patient, and she has finally beat the infection, after they removed the line. Her fever is gone, and we are left with the extreme nausea that she has been plagued with for months, since having a colonic motility study done. We hope to see surgery for a new central line today or tomorrow, and go home soon to work with all the other symptoms from home.

Thanks again for all of your help!

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Yikes. I'm glad she's doing better. Could you get a letter from a medical professional confirming that oral temps are unreliable for her and that tympanic should be used instead, to prevent this happening again?

I've had the opposite problem. Oral temps are fine for me, and accurate enough to be used to confirm ovulation. Yet I've known doctors come up with completely inaccurate tympanic temps for me, including saying it was normal when we'd just taken my temp at 34.5 orally (gallstone attack causing hypothermia). So of course, I'm in a place where the hospitals use ear thermometers, and you're in a place where they won't! Sod's law, eh.

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I'm finding this thread fascinating but don't have much to contribute at the moment, other than the fact that I can't seem to register a fever with an oral thermometer, despite having all the signs of a fever. Haven't attempted any of the other methods to check it though. For the past couple of years, my "normal" temp has been a couple degrees under what it used to be though.

Glad your daughter is doing better. Hope she continues to improve. I'll keep my eye out for anything I can find related to this topic.

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