[BLANK_AUDIO] Hi, and welcome back to the AMP lab. So far this week, Dr. Scanga explained thermoregulation, which is the process which our body uses to maintain a normal homeostasis of heat. She also talked about mechanisms through which our bodies absorb and lose heat. We also discussed some of the conditions that arise when our body can no longer maintain a normal body temperature or core temperature. Today I'm going to review briefly, how we measure temperature in a patient in a clinical setting. And how you may measure temperature on yourself or on a loved one at home. You can see here I brought a sample of some of the types of thermometers that are used to measure temperature. Here, I have a basic, digital thermometer, which is used to measure oral temperature as well as axillary temperature. This is a temporal thermometer, which measures temperature in the forehead. And next to it are some disposable thermometer strips that are also used along the forehead to estimate temperature in an emergency situation. And finally, I have a axillary excuse me, this is a tympanic thermometer which measures temperature via the external auditory canal or ear canal. So now that I've explained the different devices we have here let's get back to basics. So Ryan, why do we want to measure someone's temperature when they're in a doctor's office or when they're at home and we think that they're sick? >> When someone comes in a doctor's office, we want to make sure that we have a, that we know what their like set temperature is, or like, baseline temperature. >> Mm-hm. And another word for baseline is normal, so if someone came into the doctor's office, or clinician's office for a physical even if they're healthy, we would measure their temperature to set their baseline, or normal temperature, so that we know what that, what that is. And Ryan, this is an excellent point that you brought up. Because when we are taking someone's temperature, we're not looking at a set value to determine whether or not they have a fever or whether or not they're, they're well or their body is thermoregulating properly. Right? We're comparing our reading to their baseline, or normal temperature. So one of the challenges with measuring temperature is doing it accurately every time, doing it the same way every time. One of the problems that we often have with taking oral temperature is placement in the mouth. Sometimes you'll see, I'm going to demonstrate on Naomi here. You'll see a patient or you'll set up a loved one with a thermometer, and the thermometer will be like this, or like this, sticking out of their mouth at odd angles. And ideally, we want to place the probe of a thermometer, this is the portion that, that actually takes the reading, in a space called the sublingual pocket. That's towards the back of their tongue, underneath their tongue between their teeth and their tongue. It's this, it's called the sublingual pocket again. The reason that we're doing that, is it's, that position is close to the sublingual artery. The sublingual artery is a deep artery. And Naomi, what is that, what might that tell us? >> It's going to be able to more accurately show your core body temperature. >> Right, because that artery runs close to the core of our body, right? Now how about if I have the thermometer in the front of your mouth, like behind your incisors, near the front of your tongue? It's further away from the artery so the temperature will probably be lower. >> Right, and it would be inaccurate. Great job. Now this is something you might see at home. It's a called a temporal thermometer. It's very quick and it's very easy to use. What we do is we run the probe over the patient's forehead, very quickly and it gives us a reading. Now how it's able to give us a reading is it runs close to the temporal artery. Now I'm not going to quiz you guys on this, but here's the temporal artery, right here. That's again, that's a deep artery that gives us a good idea of how it runs close to the core of the body. Now, finally, I have the tympanic thermometer. Now, this is not as popular as it was, once was, when it was first developed. [SOUND]. >> It's a little complicated to use. But once you get the, the, once you get it placed properly it's actually a very quick reading. It's placed in the external auditory canal. Okay? And in order to get the probe up against the tympanic membrane, or the ear drum, you often have to pull the patient's ear back and apply some pressure to the probe. And that can be uncomfortable, it could be difficult to do accurately. Now the advantage of this, part from it being very quick, is it brings us close to a very important region of the brain. Now, ladies and gentlemen, what is the region of the brain that regulates our temperature? Naomi? >> The hypothalamus. >> The hypothalamus, which is in this region here. Now if I swing our model around again, [NOISE]. [BLANK_AUDIO] [NOISE] And I'll pull the probe out. [SOUND] Here we go. [NOISE] What is that probe very close to? Brian? >> Because it's next to the tympanic membrane, it's in close proximity to the hypothalamus. >> Right. So that's going to give us a very accurate reading of the core temperature, provided that we have it positioned correctly, which as I mentioned, is a little bit difficult to do. So there are two more ways of measuring temperature that you might see at home that I want to talk about. The first is an axillary temperature. The axilla is an, an anatomical term for the armpit. We use the same type of thermometer as you do for an oral temperature, and you place it in the axilla up against bare skin, hold the body close. Hold the arm close to the body, and take a reading. Now, can you guys see that there might be some problems with measuring temperature this way? Lydia, you're nodding your head. What are some, what are some problems that you, that you foresee? >> well, since it's on the outside of the body, it's not particularly close to a deep artery, so the reading might not be very close to the core temperature. >> Excellent. Right. And what if a a patient is sweating profusely? There could be, there could be some interaction with the probe, but the real problem with taking a temperature this way is placement. It's actually not that easy to place a thermometer, and get it to stay there, deep into a patient's armpit. It's not particular comfortable, and a provider, or a parent might not have time to sit there and make sure that you're not fidgeting. The second way of measuring temperature, that you might see at home, which I don't have an example of here, is a rectal thermometer. So we're not going to be demonstrating that today. This requires that a rectal thermometer is placed inside of the patient's rectum, and temperature temperature reading is made. There's a lot of problems with this way, too. It's very accurate when it's placed properly. Just like with the tympanic thermometer, it requires practice and training how to appropriately and safely place a rectal thermometer. So it's very close to the core. So Naomi, you're going to get a, an accurate reading. But it's difficult to convince someone to sit still long enough to have it placed properly. And it might be uncomfortable for them especially if they're felling very ill, to wait until their temperature's read. Formerly we would see this a lot in pediatric patients. It was understood as the best way and most accurate way to measure a child's temperature. And this is before the advent of the temporal thermometer, and the temp, the tympanic thermometer, which are much easier and less invasive than taking a rectal temperature. Do you guys have any questions about these methods of taking temperatures? No? Thank you so much for your excellent answers. I hope that we've explained some of the underpinning anatomy and physiology behind this very important vital sign. Temperature is something that seems very simple, at first, and after Dr. Scanga's lectures, and our demonstration, you can see how complicated thermoregulation and our body's temperature really is. [BLANK_AUDIO]
