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[ptingatc]

It All Started With...

Rectal Thermometry.

And I mean that in the most professional way possible. Last night we went over emergency skills and how to take rectal temperature in CBU's nursing lab. While we worked through the three hours of practicing these emergency skills, we had huge debates about everything (especially rectal thermometry) and wondered about the progress of our profession.

The purpose of taking a rectal temperature is to get an accurate core temperature reading and assess exertional heat illnesses especially heat stroke. While the rectal temperature reading is the most accurate measure out of the different temperature readings (i.e. oral, tympanic, etc.), this does not erase the issues on modesty and confidentiality of the patient when administering the rectal thermister. While as a clinician it is important to get accurate readings in everything that we do, the primary treatment method with the cold immersion tub always works 100% of the time for patients who exude signs and symptoms of heat illnesses regardless of what their core temperature was.

While I was practicing taking rectal temperatures on the mannequins in the nursing lab with Tyler, I was realizing how long it took to even get a measure. It takes three minutes to get an accurate reading with the thermister and to even position and drape the patient appropriately adds more time. Even the time to prepare the patient for measuring rectal temperature will vary due to crowd control, finding a shaded place and a cold water tub in the most convenient approach. What baffles me that in the NATA position statement regarding exertional heat illnesses, there is a huge list of other symptoms other than a rectal core temperature over 104 degrees Fahrenheit that can be identified as exertional heat stroke collectively. They even state that the "central nervous system neurologic changes are often the first marker of exertional heat illnesses", which alludes to the fact that even a core temperature reading is commonly not the biggest red flag. If we are able to reduce the core temperature quicker, we reduce the risk of morbidity significantly, so why waste time trying to reduce my patient's decency spending time dealing with crowd control and measuring a rectal temperature when I can immediately immerse my patient in a cold water tub?

But then again, there's something great about rectal thermometry and it IS its accuracy of the core body temperature.  Do I take advantage if I am in the most ideal setting and administer rectal thermometry and use the temperature reading for my assessment? I am 100% certain that this is useful in other cases such as pathophysiologies that have to do with viral or bacterial infections, but as for exertional heat illnesses or severe hypothermia, I won't waste time and do my best to bring the body back to normal body temperature. Now I think about it, maybe it would be more appropriate to take the rectal temperature after treatment of an exertional heat illness to see if it is within core body temperature!

The morning after the nursing lab seminar, Nathan and I shared a discussion about the athletic training profession and the types of athletic trainers we appreciate over a nice slam breakfast at Denny's. We definitely appreciate the ones who are prideful in their work, but even more so when they provide guidance for those who want to do the same thing. Nathan talked about his preceptor and his wife, who is also an athletic trainer being able to maintain a healthy relationship while being excellent at their careers. I mentioned how Charlie would remind me that those who want to succeed in athletic training need to have a positive mindset and a productive relationship with everyone they work with. Besides the interpersonal and the interprofessional aspects of athletic training, the skill set of an athletic trainer is growing. When we have opportunities to work in areas outside of the athletic world such as in hospitals as physician extenders and in the performance arts setting, it is safe to say that athletic trainers are jacks of all trades. If we are able to deal with emergencies and have knowledge of the equipment and protocols that EMTs and paramedics have, all we need is the world to respect what we can offer to them when it comes to those situations.

Nathan and I agree that the profession is headed in the right direction, but we were discussing from a student standpoint and maybe we are simply being hopeful and dream of utmost respects and salaries. We have already heard of how the salary of an athletic trainer is not weighed with the skill set and the competence, but yet again, we want to be athletic trainers because we love the work we put in and we want to provide the best health care to our patients through injury prevention and emergency response.