А . Questions for self-checking:

1. Fill in colunm:

№	Task		Answer
1.	General characteristic of gunshot wounds.
2.	What is “traumatic illness”?
3.	Periods of traumatic illness.
4.	Clinical features of traumatic illness at maxillofacial wounded.
№	Characteristic of phase of shock			The name of phase of shock
1.	It is arises directly after extraordinary mechanical influence and characterized by motive and speech excitement of the victim, tachycardia, paleness of skin integument, increase systolic blood pressure, sometimes spontaneous urination and defekation.
2.	It is characterized by dispny, an oliguriya, increase of rectal-skin gradient of temperature, block of the victim, tachycardia, decrease of systolic blood pressure.
Periods of traumatic illness.		Answer
First
Second
third
fourth

B. Tasks for self-checking: 1. Patient A., 42y was caught under blockage at quarry. The left half of face and left leg were smash by stones for 4 hours. Well-being is normal, blood pressure is 110/70 mm m c. Pulse 80 at minute. The doctor was at place when the patient was getting under blockage. The condition gets worse. Complaints become at strong pain at left half of face and leg. Patient is inconvenient. Skin is pallid. blood pressure is 80/50 mm m c. Silk pulse 130 at minute. Patient was getting to the hospital. What is the reason of worse of patient’s condition? (Answer: patient has traumatic illness (syndrome of mutual additional burden). Because of doctor’s mistake the “tourniquet” shock becomes).

2. Patient B., 51 y, was getting to hospital at 40 min after damage in bed condition. The fracture of maxilla Le Fort II, fracture of right VІ, VІІ, VІІІ ribs traumatic shock are diagnosed. What the succession of measures at first hours of treatment? (Answer: to get patient out from shock: use anti-shock, analgetic and blood drugs. Patient should be consulted by maxillofacial surgeon, neurosurgeon, traumatologist. It is possible to use the apparatus of Zbarazh).

3. Patient B., was getting to hospital after fight. Behavior of patient is inadequate. Vomiting was twice. Skin is pallid, hematomas are at infraorbital areas, there are abrasions. Nasal bleeding was. The middle face is long. Blood pressure is 100/60 mm m c, pulse 104 at min temperature is normal. What is diagnosis? (Answer: traumatic illness, complex trauma: close brain damage, fracture of maxilla Le Fort ІІ).

C. Matherials for test control. Test tasks with one right answer (α = II): 1. Typical features of trauma of maxillofacial area are:А. disfiguration of face;В. Discrepancy of appearance of victim to hardness of trauma; С. Complex trauma of head and brain; D. traumatic shock; Е. All answers are correct. (correct answer: Е).

2. Specific signs of traumatic illness:А. surprise of beginning, etiological agent and morphological substrate (damage of organ or tissue); В. surprise of beginning, absence of latent period, malfunction of mastication;С. Traumatic shock, massive blood loss;D. Hemorrhagic shock, pain syndrome; Е. surprise of beginning, absence of latent period, etiological agent and morphological substrate (damage of organ or tissue), pain syndrome, multiple organ failure.(correct answer: Е).

3. Non-specific signs of traumatic illness:А. Traumatic shock, stress; В. Hemorrhagic shock, aseptic or purulent inflammation; С. fever, pain, general malaise, physical and emotional weakness; D. periods of disease – initiate, height and result; Е. All answers are correct. (correct answer: Е).

D. Educational tasks of 3 th levels (atypical tasks): 1. The patient was getting in a reception of hospital after road accident is delivered. There is the trauma of midle face. The patient is in consciousness, is a little raised, integuments pale, pulse of 100 blows in min., the blood pressure is 100/60 mm of mercury. Body temperature is normal. After carrying out radiological inspection the diagnosis is established: traumatic fracture of the maxilla across Le Fort ІІ. Make the preliminary diagnosis. What additional data and clinical data are necessary for establishment of the final diagnosis? Make the treatment plan. (Answer: 1. Traumatic illness, fracture of the maxilla across Le Fort ІІ. 2. This subjective and objective inspection of the patient, the inspections given of additional methods. 3. Consultation of the neurosurgeon for close craniocerebral trauma. Reposition, fixing, immobilization fragments of jaws, medicamentous therapy).

2. The patient was getting in a reception of hospital injured on production. The patient is in consciousness; there is a little raised, integuments pale, pulse of 110 in min., the blood pressure is 90/60 mm of mercury. Body temperature of 35,6 °C, breath speeded up. Objectively: there is asymmetry of the face at the expense of flattening of the right infraorbital area. Nasal bleeding. At a palpation of the damaged site – pain and a krepitation, "step" existence on bottom edge of the right orbit. From the anamnesis it is known that the patient has a chronic rinogenny antritis, after receiving a trauma there was a vomiting twice. Make the preliminary diagnosis. What additional data and clinical data are necessary for establishment of the final diagnosis? Make the treatment plan. Whether has value existence of chronic rinogenny antritis for scheduling of treatment and the course of a disease? (Answer: 1. Traumatic illness, fracture of the right malar bone. 2. There are subjective and objective inspection of the patient, the inspections given of additional methods 3. Consultation of the neurosurgeon for close craniocerebral trauma. Reposition, fixing, immobilization отломков malar bone, medicamentous therapy. 4. Existence of chronic rinogenny antritis for scheduling of treatment of value has no (if there is no aggravation stage), the course of a disease can become complicated if the fracture of a malar bone getting into a maxillary sine) takes place.

3. The patient B., was getting to maxillofacial department with gunshot wound of face. Condition of the patient is average weight, consciousness confused, integuments pale, pulse of 130 blows in min., the blood pressure is 90/60 mm of mercury. Body temperature of 35,4 °C, breath speeded up. Objectively: threre is asymmetry of the face at the expense of flattening of midlleface. There is bleeding from a nose and ears. At a palpation of the damaged site – pain and a krepitation, "step" existence on bottom edge of the right and left orbits, mobility of the maxilla and nose bones. Make the preliminary diagnosis. What additional data and clinical data are necessary for establishment of the final diagnosis? Make the treatment plan. (Answer: 1. Traumatic illness, fire fracture of the maxilla across Le Fort ІІІ (the top type). 2. This is subjective and objective inspection of the patient, the inspections given of additional methods. 3. Consultation of the neurosurgeon for close craniocerebral trauma exception. Reposition, fixing, immobilization of fragments of bone, medicamentous therapy).

 

Тема № 6. EARLY COMPLICATIONS OF DAMAGES OF MAXILLOFACIAL AREA (CRUSH-SYNDROME). mEDICAL AID AT STAGES OF MEDICAL EVACUATION. CONCOMITANT COMPLICATIONS AT DAMAGES OF MAXILLOFACIAL AREA (BLEEDING, ASPHYXIA, SHOCK), ITS PROFILAXIS.

1. Actuality of theme: Knowlegess of general characteristic, clinic, principles of diagnostic and profilaxis of complications of traumatic damages of maxillofacial area is necessary for stomatologist for it is essential to lower a share of serious consequences of injuries of a face and to increase quality of life of patients.

2. СONCRETE AIMS: 1. To analyze reasons of traumatic injuries of maxillofacial area and its complications. 2. To explain clinical features of traumatic injuries of maxillofacial area and its complications.3. To propose methods of diagnostic traumatic injuries of maxillofacial area and its complications.4. To classify complications of traumatic injuries of maxillofacial area.5. To tract clinical features traumatic injuries of maxillofacial area and its complications. 6. To draw the scheme of organization of treatment of patients with complications of traumatic injuries of maxillofacial area.7. To analyze principles of prophylaxis and treatment of complications of traumatic injuries of maxillofacial area. 8. To prescribe medical therapy of victims with traumatic injuries of maxillofacial area and its complications.

3. BASIC KNOWLEDGE, ABILITIES, SKILLS, WHICH are NECESSARY FOR STUDY THEMES (intradisciplinary integration).