[A new type of medical thermometer: the disposable buccal thermometer].
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The Clinitemp Fever Detector (Clinitemp) is a newly marketed thermometer consisting of plasticencased thermophototropic esters of cholesterol that change color over a specific short-range of temperature. The manufacturer states that the instrument can identify fever by measuring skin temperature in children. On the basis of a patient's report of one inaccurate Clinitemp, we undertook to investigate the accuracy of this thermometer. One hundred fifty-two children presenting to the Children's Hospital Emergency Room had their temperature taken with two thermometers, an electronic thermometer that had been checked for accuracy with a National Bureau of Standards thermometer and the Clinitemp. Clinitemps, purchased over a two-month period from three pharmacies, were tested on different children. Thirteen of thirty children (43%) with fever (rectal temperature greater than or equal to 38.3 C (101 F) or oral temperature greater than or equal to (37.8 C) (100 F) identified by the electronic thermometer, were correctly classified as having fever using the Clinitemp. When fever was defined to include children with a rectal temperature greater than or equal to 38.0 C (100.5 F) or an oral temperature of greater than or equal to 37.4 C (99.5 F), the Clinitemp correctly identified 13 (32.5%) of 40 children with fever. There appears to be an appreciable risk that someone with a serious illness may delay seeking medical attention on the basis of a normal temperature as measured by the Clinitemp.
For rapid measurement of the human body temperature, three modifications of medical digital thermometer are recommended for clinics: a thermometer with compensation of the body's local cooling by a transducer, thermometer for cardiosurgery, and adaptive thermometer. The article describes the basic structural scheme of the medical digital thermometer, ways of accelerated temperature measurement and main technical characteristics of the above models.
I discuss the traceability of calibration of electronic thermometers to thermometric constants of nature or to the National Bureau of Standards, form a manufacturer's basic standards through the manufacturing process to the user's laboratory. Useful electrical temperature sensors, their advantages, and means for resolving their disadvantages are described. I summarize our development of a cell for realizing the melting phase equilibrium of pure gallium (at 29.770 degrees C) as a thermometer calibration fixed point, and enumerate its advantages in the routine calibration verification of electrical thermometers in the clinical chemistry laboratory.
Between June 16 and October 9, 1974, 9 neonates at a small, community hospital were stricken with an unusual, serious illness manifested by peritonitis and pneumoperitoneum; 3 died. Although the illness was initially thought to be necrotizing entercolitis, clinical, laboratory, and epidemiologic evidence strongly suggested that it was instead the result of gastrointestinal perforation. in case-control studies employing 3 different conposure to a particular nurses' aide. Other studies including a comparison of expected and actual exposures of ill infants to nursery personnel further linked this nurses' aide to illness. Since rectal temperature-taking was the only procedure possibly predisposing to gastrointestinal perforation that was routinely practiced in the nursery, it was hypothesized that the illness might be the result of rectal perforations. In order that rectal temperature-taking technique could be observed, each nurse and nurses' aide on the OB-GYN service was asked to take part in a general practical examination of nursing skills on a life-like baby doll. The mean and median depths to which nursing personnel inserted the thermometer exceeded the maximum depth recommended to prevent perforation. The nurses' aide epidemiologically associated with illness inserted the thermometer to almost twice the maximum recommended depth-farther than all the personnel who worked primarily in the nursery. After this nurses' aide was removed from the nursery and axillary temperature-taking replaced rectal temperature-taking as the nursery routine, the outbreak ceased.
Three neonates with rectal perforations probably caused by the use of the rectal thermometer, are reported. The dangers of this condition and the difficulty of diagnosis even at laporatomy are emphasised. It is suggested that since the axillary temperature in the neonate is an adequate reflection of the core temperature the routine use of the rectal thermometer, except in exceptional circumstances, should cease.
We have investigated the equilibrium melting point of gallium as a temperature fixed-point at which to calibrate small thermistor thermometers, such as those used to measure temperature in enzyme reaction analysis and other temperature-dependent biological assays. We have determined that the melting temperature of "6N" (99.999% pure) gallium is 29.770 +/- 0.002 degrees C, and that the constant-temperature plateau can be prolonged for several hours. We have designed a simple automated apparatus that exploits this phenomenon and that permits routine calibration verification of thermistor temperature probes throughout the laboratory day. We describe the physics of the gallium melt, and the design and use of the apparatus.
The possible complications in two women who had injected themselves intravenously with thermometer mercury with suicidal intent are discussed with reference to the few comparable cases. A manifest pulmonary hypertension due to multiple mercury emboli in the lesser circulation in one patient who developed a dyspnoea on exertion could be excluded by cardiac catheterization. Signs of acute and chronic mercury poisoning could not be demonstrated in our patients, in contrast to some cases reported in the literature. So far, specific therapy has therefore been dispensed with.
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Forehead skin temperature measured by a stip of liquid-crystal material was compared to esophageal, rectal, and axillary temperatures measured by thermistor probes in patients having general anesthesia for coronary artery bypass grafting. Before extracorporeal circulation, forehead skin temperature was lower than axillary, rectal, and esophageal temperatures by approximately 2.2 C (4.0 F). During rapid warming, forehead skin temperature rose concurrently with the other temperatures measured but remained significantly different. The liquid-crystal strip may be useful as a safe, convenient method for routine monitoring of temperature trends during general anesthesia in patients whose exact core temperature need not be continuously monitored. We believe that infants, patients undergoing extracorporeal circulation, major abdominal, vascular, or neurosurgical procedures, or patients with a history of temperature regulatory problem are probably best monitored by a method which more exactly reflects core temperature.
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