[lil-hosp.usa]

Was wondering what protocol everone was using out there for triaging our calls concerning children and high temps/muscle aches. We use a book called telephone triage and go by that forgive I don't know the author.

[eltrip]

Our protocols come from Dr. Barton Schmitt. They are included in our software package.

[G'smommy]

We use Barton Schmitt as well. Unfortunately I have use a ratty book b/c I don't have it on my computer.

[flspedi]

We have Barton Schmitt but most of the triagers don't use it. We do the standard, fluids, treat the temp, rest, appt with in 48hrs of onset to test and start tamiflu.

[eltrip]

Originally Posted by flspedi

We have Barton Schmitt but most of the triagers don't use it. We do the standard, fluids, treat the temp, rest, appt with in 48hrs of onset to test and start tamiflu.

Out of curiosity, is this done by the specific physicians' orders? If not, what would you use as a defense if questioned about not using the algorithms?

[flspedi]

Well we are in house/staff nurses that answer questions/concerns. We don't have a specific protocol-the barton schmitt is there to help guide us if we haven't a clue on what to say, but typically I'll just ask the doctor and call the parents back. We don't have any set things/questions/just cover the basics and document.

[Noryn]

When I worked telephone triage we were instructed to not treat a fever unless it was 102. They did not need ER eval unless the temp was 105 and a fever was not harmful until it was 107-108. We did use Barton Schmitt guidelines which at that time stated that fever was a body's defense and usually was self limiting.

I personally didnt agree (and typically didnt go by those) but I will also admit that I am nowhere near qualified to take on Barton Scmitt. I will say that when I worked in the ER I saw many children come in with a fever of 103 ish who would have febrile seizures. But my companies argument for this was that febrile seizures arent harmful.

Ultimately I quit, I just didnt agree with those guidelines. I do think the research may very well support those guidelines.

[flspedi]

We don't recommend treatment until over 100.4, of course many parents will still treat at 99, but it's not recommended. We give meds in office if they have a fever over 100.4 and are due for meds, so I personally disagree with not treating until 102. As far as not critical until 105 I do agree-I advise if upper 104's do a tepid bath, cool fluids, and give meds if time, if 1 hour later temp has not decreased or has increased okay to either call again or just go to ED, but temps aren't dangerous until the 107-108. Febrile seizures aren't harmful just scary. As long as you know what to do during a seizure and don't freak out the most usual complication is head trauma from falling or aspirating if vomiting occurs if not on side. Kids can have febile seizures at 101 if it came on so suddenly the body couldn't adjust.

[eltrip]

I had the priviledge of hearing Dr. Schmitt speak about fever in October. His research-based information on treating fever gave me a much better understanding of how (& when) to treat my own child's fever.

I stick with the guidelines. But hey, I'm supposed to do that.