EMS Clinical Symposiums

Question 1

What are Ulcers?

Answer 1

A local defect, or excavation of the surface of an organ or tissue that is produced by sloughing of inflammatory necrotic tissue.
It is a loss of area of epidermis and dermis to produce a defect, even down to fat, muscle, tendons and bone.

Question 2

What is the main cause of leg ulcers?

Answer 2

Vascular (90%) mainly due to: valvular incompetence, DVTs, obesity & immobility)

Question 3

What are some features of neuropathic ulcers?

Answer 3

• Distal polyneuropathy (motor/sensory/autonomic)
• Under metatarsal heads / heel
• Painless but warm with pulses
• Causes: diabetes, alcohol, B1/12 deficiency…

Question 4

What are the stages of Wound Healing by First Intention?

Answer 4

(for wounds with tissue loss or margins not apposed, eg- ulcer)

1. Ulcer defect created
2. Granulation tissue (to fill in defects & repaid specialised tissue lost)
3. Organisation
4. Early fibrous scar
5. Scar contraction

Question 5

Types of emboli?

Answer 5

•	Thrombus (99%) 
Systemic – from arterial system  
Pulmonary – from deep veins
Atheroma / platelets
•	Infective
•	Tumour 
•	Gas – e.g. air or nitrogen
•	Amniotic fluid
•	Fat / bone marrow
•	Foreign material

Question 6

In why circumstances should a doctor call a coroner?

Answer 6

• Deaths from violence
• Deaths following abortion
• Occupational deaths (industrial diseases)
• Deaths from poison/ alcoholism
• Deaths from surgical operations/ anaesthesia
• Deaths of unknown causes