Ostomies

[LucidResq]

Yesterday on a ride-along we ran on a difficulty breathing call. The woman had a colostomy (seemed pretty irrelevant to her CC).

The medic questioned her about a potential blockage and if everything had been coming out normally.

What other considerations should one take with an ostomy pt?

What kind of history should be taken?

Besides blockage, are there other acute conditions a person with an ostomy may face?

 

[Airwaygoddess]

Infection, dehydration, fissures, stoma size changes.

 

[BossyCow]

I had one recently that came across the radio as "Difficulty with ostomy" Pt complaining of bleeding around ostomy site.

Ended up an end stage bowel cancer pt who was two states away from her primary physician and since moving a year ago hadn't been seen. Found her on her hands and knees in the bathroom with blood and bag contents (to put it nicely) about a foot and a half up the bathroom wall.

Apparently after a night of binge drinking, she woke up with what she thought was a hangover. Stomach cramps followed by gushing blood from the ostomy site. Upon examination, no bag, no tube, just insides with a desire to become outsides.

Later in the ER writing up our reports, the medic who did the ALS support on this looks at me and says.. "What do you think that was coming out of that hole.. bowel?" I said... no.. the technical term is 'guts'

Pt was crumping when we left. We got toned out for a house fire as we were leaving the ER so I haven't heard what the outcome was. She wasn't doing well at all. Before doing an initial BP I generally ask what their normal BP is so I get an idea of where to start. She laughed and said.. Oh.. 250-something! Her initial pressure was 152/80 and when we walked into the ER with her 30 minutes later, it was 92/54. I had a green new EMT with me and she kept thinking she wasn't taking the pressure right because it dropped so fast.

I also had a stoma pt who grabbed her bag while seizing. That was purty!

 

[Ops Paramedic]

Although her colostomy had nothing to do with her chief complaint, one would still have to question the patient with regards t it, as well perform a physical exam and inspection to ensure that all is tact (To the best of your knowledge). And as you did, the best person to ask, is the patient self. The patient would not have been discharged from hospital unless she had trainig in how to maintain it and faultfinding.

Be carefull of the bodily fluids in case it bursts. It can also be very embarising for the patient, as they also have to pass wind via the colostomy, so close your nose in time!!