Basic therms, parametrs, characterics whith are nessesery during preparation to lesson.

Therm	Definition
1. Traumatis illness	It is the special clinical category, which is allowing to consider separate stages and complications (shock, the postshock period, infectious complications, the reconvalescence and rehabilitation periods), and all process as a whole to definition of an outcome of a disease.
2. Traumatic shock	This serious condition caused by a trauma, being accompanied the expressed violations of functions of vitals, first of all blood circulation and breath. It is characterized by two phases of a current – erectile (tension, active reaction of an organism to a trauma) and torpent (exhaustions of the main functions of life support). Shock isn't a nosological form. It represents a phase of a traumatic illness.
3. Hemorrhagic shock	This condition is similar on a clinical picture to traumatic shock. Arises owing to massive blood loss in case of a trauma (external bleeding) or at internal bleedings.
4. Hypovolemic shock	This condition is developing at considerable losses by an organism of plasma of blood and other liquids (the considerable burn surfaces, exhausting vomiting, diarrhea, etc.) when volume of circulated blood is directly decreases.
5. The mutual additional burden syndrome	This condition, is characterized by such symptoms: large quantity of the centers afferentny pathological (first of all painful) impulsation; large quantity of the centers of bleedings; violation of coordinating function of the central nervous system at heavy shock and a craniocereberal trauma; a large quantity of the centers primary, and then and a secondary necrosis of tissues that leads to intoxication development.

4.2. Theoretical questions for lesson: traumatic illness, pathogeny, classification, prognosis, treatment, complications.

4.3. Practical skills for lesson: 1. To investigate the patient with trauma of maxillofacial area, make diagnosis, prescribe treatment. 2. Fill in medical documentation. 3. To make primary surgical treatment of wound. 4. To make the temporal immobilization of jaws.

5. TABLE OF CONTENTS OF THEME:

Polytrauma and traumatic illness of the maxillofacial wounded

 Polytrauma is monotonous defeats of two and more anatomic areas at which violations of the vital functions of an organism. It is a heavy combined trauma which is accompanied by development of clinic of traumatic shock, that is, it is a shockogenic combined trauma. Polytrauma allocation in separate category is important in connection with certain features of such wounds. Combination of damages of several anatomic areas of a body - the pathological condition connected with emergence of a syndrome of mutual burdening. The essence of a syndrome is that each of damages worsens the general pathological situation and each concrete damage at a polytrauma proceeds more hard, with big risk of development of complications, than at the isolated trauma. Despite of a big variety of clinical options of a shockogenic combined trauma, at a polytrauma the traumatic illness which has the general regularities, its defining main features of pathogenesis and principles of medical tactics develops.

Traumatic illness– complex of symptoms of the injured patients with heavy, multiple damages; it is the pathological process predetermined by a heavy shockogenic mechanical trauma in which consecutive change of key factors of pathogenesis defines natural sequence of the periods of a clinical current. The concept about a traumatic illness was formed on the basis of the doctrine about traumatic shock. At the heart of a traumatic illness protective and reflex reaction of an organism, first of all, central nervous system, endocrine and other systems on action of the injuring agent, nervous impulses and absorptions of products of disintegration of tissues in the damage center, blood loss lies.

The clinical symptomatology and the course of a traumatic illness depends on localization, character and weight of damage.

Periods of traumatic illness:

The shock period - the period of sharp functional and system frustration which are predetermined by a heavy trauma, duration of 12-48 hours.

The early post-shock period - the period of threat of emergence of organ and polyorgan insufficiency - duration is 3-7 days after a trauma.

The period of infectious complications or big risk of their development (the period of a secondary immunodeficiency) - duration from 1 week - till 1 month.

The reconvalescence period - duration is from several weeks about several months.

A.V.Kaplan allocates such periods of a traumatic illness:

I - period of traumatic shock and bleeding;

II - the period of a heat of changes of a homeostasis (the general changes together with pathomorphological changes of the damaged tissues);

III - the reconvalescence period with development of conditions for reparative process of the damaged tissues and bodies.

Pathogenesis of a traumatic illness is predetermined by interaction of the traumatic agent with organism tissues owing to what there are their damages which influence different systems of an organism, thus the main links of pathogenesis include blood loss (the different volume, speed), specific disorders of functions of the damaged bodies, a hypoxia, a toxemia and a pain syndrome. As a result, there is a mono - or polyorgan insufficiency.

At a trauma of reaction of damage are replaced with protection reactions - a stress, or the general adaptation syndrome in reply to a trauma. Distinguish two phases of a metabolism after a trauma: the catabolism - lasts 2-4 days, is characterized by destruction, loss of proteins that not directed reduction of damages of structures and preservation of the main functions of an organism; anabolic the phase - lasts 1-2 weeks and more, for it renewal of the damaged structures and bodies and renewal of their function is inherent.

"Primary" changes result from direct anatomic defeat of body. In process of increase in power of injuring effect decreases weight of primary changes. For example bruise, gap, concussion.

6. MATHERIALS FOR SELF-CHECKING: