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

Therm	Definition
1. Asphyxia	This is asthma caused by oxygen starvation and excess of carbonic acid in blood and tissues, for example at compretion of respiratory ways from the outside (suffocation), closing of their gleam with hypostasis, pressure drop, etc.
2. Bleeding	It is blood loss from blood system. Blood can follow from blood vessels in an organism or outside, or from natural openings, such as a mouth, a nose, etc., or through injuries of skin.
3. Crash-syndrome	This is condition which arises owing to long violation of blood supply (ischemia) of the squeezed soft tissues; the toxicosis which is characterizing, except local, system pathological changes in a type of a hyperkaliemia and kidney insufficiency. It meets at victims at earthquakes, blockages in mines, collapses, etc.

4.2. Theoretical questions for lesson: 1. Anatomic-physiological features of maxillofacial area. 2. Statistic of early complications of traumatic injuries of maxillofacial area.3. Classification of early complications of traumatic injuries of maxillofacial area.4. Reasons of early complications of traumatic injuries of maxillofacial area.5. Clinic of early complications of traumatic injuries of maxillofacial area.6. Emergency aid and treatment of early complications of traumatic injuries of maxillofacial area.7. Prophylaxis of early complications of traumatic injuries of maxillofacial area.

4.3. Practical skills for lesson: 1.To investigate patient with complications of traumatic injures of maxillofacial area, make diagnosis and prescribe treatment. 2. Fill in medical documentation. 3. To do primary surgical treatment of wound. 4. To make emergence aid at early complications of damages of maxillofacial area.

5. TABLE OF CONTENTS OF THEME:

Classification of complications of damages of maxillofacial area. 

Complications of gunshot wounds are: the direct; the early; the late. Direct complications - asphyxia, bleeding, shock, collapse, the sharp respiratory insufficiency. Early complications - growth of sharp respiratory insufficiency, a lump, a syndrome of disorder of water-salt balance, early bleeding. Late complications - secondary bleeding, bronho-pulmonary frustration, traumatic and fire osteomyelitis, traumatic artritis, salivary fistulas, contractures and ankilosis of TMJ, a false joint, defects and deformations of the face, mental and neurologic violations.

Syndrome of long squeezing of tissues (synonyms: compartment-syndrome, crash-syndrome, traumatic toxicosis, syndrome (long) crush, compression trauma, crush syndrome) - which arises owing to long violation of blood supply (ischemia) of the squeezed soft tissues, toxicosis which is characterized, except local, system pathological changes in a type of a hyperkaliaemya and kidney insufficiency. Meets at victims at earthquakes, blockages in mines, collapses, etc.

Consider that at a syndrome of long squeezing of fabrics there is an absorption of toxic products from the crushed muscles. It is established that the damaged muscular tissues loses 75% of a myoglobin, 70% - creatinine, 66% - potassium, 75% of phosphorus. After release from compression these substances arrive to the blood course, there is an acidosis, the heavy general and, first of all, geodynamic frustration. It is necessary to emphasize that clinical manifestations arise only after elimination of a factor of squeezing.

There is a deep necrosis of tissues which leads to organism self-poisoning with products of disintegration of tissues and a serious condition of the victim.

After release from compression shock, as a rule, develops. Since 3-4 days, local symptoms are shown: dense hypostasis, pallor, violation of function of bodies and kidney insufficiency, oligury which passes to an anury. Because in the first days of a disease symptoms aren't expressed, ineffective late treatment can be carried out.

Special form of a crash-syndrome is the positional compression - compression of parts of a body at a long sleeping in alcohol intoxication or in unconsciousness. Early symptoms indistinct, for the 3-4th days begin sharp clinical manifestations, sharp kidney insufficiency develops.

Clinical forms

1. Easy - arises in cases when duration of a compression doesn't exceed 4 hours.

2. Average - compression of considerable sites for 6 hours. In most cases there are no expressed haemo dynamic frustration, and function of kidneys suffers a little.

3. The heavy form arises owing to compression of considerable sites over 7-8 hours. The symptomatology of kidney insufficiency and haemodynamic frustration is accurately shown.

4. The heaviest form develops if very big sites (for example both extremities) for 6 hours and are squeezed more. Victims die of sharp kidney insufficiency for the first 2-3 days.

Treatment. On a place of trauma is necessary to make application of tourniquet, cold on the damaged site. Further treatment is directed on renewal of blood circulation, fight against a toxemia, sharp kidney insufficiency. From surgical methods of treatment apply a dissection of the struck sites. The forecast at development of sharp kidney insufficiency are adverse.

At the correct and timely treatment for 10-12 days of the phenomenon of kidney insufficiency gradually abate. Further hypostasis and pains gradually decrease and until the end of the first month of treatment completely disappear.

Asphyxias

Type of asphyxia	%	Pathogenesis	Medical aid
Dislocational	40	Dislocation of tongue, fragments of mandible.	Fixation of tongue at right position. Reposition and fixation of fragments of jaws.
Obturational	29	Closing of the top respiratory ways with a foreign matter, blood clot.	Removal of a foreign matter, blood clot, and at impossibility - a tracheotomy, a tracheostomy.
Stenotic	23	Trachea compression by hypostasis, neck hematoma.	Conicotomy, tracheotomy
Valvate	5	Closing of an entrance to a throat by flaps of soft tissues from a soft palate, language and so forth.	Anchoring of a hanging-down rag or its cutting off. Fixation of flap by the tire with the holding plane.
Aspirational	3	Aspiration by blood and vomit masses.	Suction of contents of respiratory ways by means of the device or a rubber tube which is entered into a trachea.

Bleedings can be primary (at the time of a trauma) and secondary (early and late). Early bleedings arise at a blood clot separation when transporting the wounded or as a result of a rupture of vessels in the absence of a reliable transport immobilization of fragmеnts of jaws at the first 24-48 hours after trauma.

Late bleedings result from purulent fusion of blood clot or a wall of partially damaged vessel in 7-14 days or as a result of a vessel erosion in 3-4 weeks. Late bleedings arise suddenly, is more often at night, they are profuse, are life-threatening the wounded. Some hours prior to bleeding it is possible to notice harbingers: ichors from a wound, emergence of pain in depths of a wound, hypostasis or its increase.

First aid: tamponade of wounds; imposing of a pressing bandage; digital occlusion of vessels at small bleedings from branches and artery carotis externa.

Medical aid: Bleeding can be stopped by vessel bandaging in a wound, imposing of a styptic clip on a bleeding vessel, or bandaging on an extent. Bandaging of vessels on an extent carry out at wounds of big branches from artery carotis externa (external carotid).

Traumatic shock - sharp oppression of all vital functions of an organism in reply to action of a superstrong injuring factor. After a short phase of excitement of central nervous system patient  falls into a condition of braking which is shown: violation of the central haemodynamics - sharp falling of arterial pressure, warm activity, gipovolemiy; microcirculation violation - viscosity of blood which conducts to stasis and to thrombosis decreases; violation of transcapillary blood circulation - hypostasis of tissues develops and the oxygen exchange which conducts to hypoxia of tissues is broken.

At damages of maxillofacial area shock also can be hypovolemic (as a result of blood loss).

Medical aid: 1) warming of the wounded, including by reception per os alcohol, and anesthesia - 1-2 ml of 1% of solution of promedol intramuscularly or intravenously on 200 ml of 0,5% of solution of novocaine, novocain blockade;

2) renewal of passability of respiratory ways and oxygenotherapy;

3) compensation of plasma loss as a result of blood circulation centralization under control of the central venous pressure (in norm of 70-130 mm hg) and diuresis (at an o'clock 50-60 ml of urine have to be allocated) by intravenous drop injection reopolyglucin, Ringer's solution with heparin (t0 of solutions 370);

4) renewal of a vascular tone – intravenously 1 ml of 0,1% of solution of noradrenaline in 200 ml of physical solution, and at insufficient effect of vazoconstrictor add corticosteroids - 125 mg of a hydrocortisone or 60-90 mg of Prednisolonum;

5) correction of acid-base balance - intravenously 60-120 mg of 4% of solution of bicarbonate of sodium (it is desirable under control of the corresponding indicators).

Prevention of emergence of asphyxia and acute respiratory insufficiency

Prevention of emergence of dislocation asphyxia which develops as a result of shift of fragments of jaws, giving to a body of affected situation by the person from top to bottom or aside and imposing of the standard tire for a temporary immobilization of fragments of jaws is. The victims being in an unconscious condition, will evacuate in situation on one side, and persons who didn't faint, - in situation semi-sitting or semi-lying.

Prevention of obturational and aspiration asphyxia provides release of respiratory ways from foreign matters, blood, emetic masses.

Prevention of emergence of stenotic asphyxia at the first signs of sharp respiratory shortage includes carrying out anti-edematous therapy if there is a bleeding on a neck, it is necessary to tie up a bleeding vessel, and to remove blood from back sites of a throat. If these actions are inefficient, a necessary conicotomy or a tracheotomy.

Prevention of valvate asphyxia - a conicotomy or a tracheotomy.

Prevention of respiratory insufficiency - release of an oral cavity and a nose from emetic masses, an oxygen insuflyation.

Prevention of emergence of secondary late bleedings: timely exhaustive surgical processing of the struck site, application of antibacterial means. All patients with harbingers of secondary bleeding are under special supervision.

6. MATHERIALS FOR SELF-CHECKING: