TMTraumaMaster Academy

2026-10-15

创伤口袋卡Trauma pocket cards

临床审核进行中。选卡查数字、判断点和升级条件；展开查看来源差异。Clinical review ongoing. Select cards for numbers, decision points and escalation; expand for source differences.

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TXA：时间与方案TXA: timing and regimen

成人创伤活动/疑似严重出血；从受伤起算。Adults with active/suspected major traumatic bleeding; time from injury.

  1. ≤3 h；1 g 静滴 ≥10 min → 1 g 静脉维持 8 h。≤3 h; 1 g IV over ≥10 min → 1 g IV over 8 h.
  2. 尽早使用；国内 R33 维持表述为“8 h以上”，欧洲 R23 为8 h。Give early; Chinese R33 states at least eight hours for maintenance, European R23 eight hours.
  3. 超过3 h不常规使用；仅有黏弹性检测纤溶亢进证据时由上级结合本院方案决定，已知纤溶抑制者不用。Beyond three hours, not routine; only with viscoelastic hyperfibrinolysis evidence and senior/local-policy review; avoid known fibrinolytic shutdown.

中国休克共识2023Chinese shock2023 · 欧洲出血2023European bleeding2023 · NICE NG39NICE NG39

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

按本院药品说明书、配制及输注流程执行；不得快速静推。Follow local product, preparation and infusion policy; avoid rapid IV push.

审核记录Review record

打开原课Open course

成人出血：血压目标Adult bleeding: BP target

止血前、无颅脑/脊髓损伤的成人初期出血。Early adult bleeding before control, without brain/spinal injury.

  1. SBP 80–90 mmHg。SBP 80–90 mmHg.
  2. 老年、慢性高血压慎重；儿童与孕妇另按专门方案。Caution with older age/chronic hypertension; separate pediatric/pregnancy protocols.
  3. 目标达不到可按欧洲R14加去甲肾上腺素；国内R28在MAP<50或SBP<70危及生命时考虑，不能替代血液和止血。If targets fail, consider norepinephrine (European R14); Chinese R28 considers it in life-threatening MAP below 50 or SBP below 70, alongside blood/control rather than replacing them.

中国休克共识2023Chinese shock2023 · 欧洲出血2023European bleeding2023

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

国内R22与欧洲R13支持有条件的目标；不是所有伤者通用。Chinese R22 / European R13 support conditional use, not a universal target.

审核记录Review record

打开原课Open course

休克指数Shock index

成人风险识别，结合查体与趋势。Adult risk recognition, with examination and trends.

  1. SI≥1 或脉压<30 mmHg（国内R2）SI at least one or pulse pressure below 30 mmHg (Chinese R2)
  2. 国内表2：SI≥1.0/≥1.5/≥2.0粗估失血20–30%/30–50%/50–70%；β阻滞剂、老幼及运动员可失真，不能当精确失血量。Chinese Table 2: SI at least 1.0/1.5/2.0 roughly associates with20–30%/30–50%/50–70% loss; beta blockers, age and athletic physiology confound it, so not precise volume.
  3. 药物抑制心率或老人“正常”生命体征仍保留休克担心。Blunted HR or apparently normal older-adult vitals do not exclude shock.

中国休克共识2023Chinese shock2023 · 欧洲出血2023European bleeding2023

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

欧洲R5用SI和/或脉压评估休克与输血需求；同时看机制、意识、灌注、乳酸和反应。European R5 uses SI and/or pulse pressure for shock/transfusion assessment; integrate mechanism, consciousness, perfusion, lactate and response.

审核记录Review record

打开原课Open course

大量输血启动评估MTP activation assessment

成人；ACS TQIP 评分示例。Adults; ACS TQIP example.

  1. ABC ≥2 + 临床状态。ABC ≥2 + clinical state.
  2. 穿透躯干伤、FAST阳性、HR≥120、SBP≤90各1分；ABC≥2启动评估；原版等号边界与本院版本核对。Penetrating torso injury, positive FAST, HR at least 120 and SBP at most90 each score one; ABC at least two triggers assessment; verify local boundaries.
  3. 抢救室已输血、需手术/介入止血也是TQIP触发因素；结合持续出血和复苏反应，不等24 h累计10 U。Blood already required in the bay and operative/interventional control are TQIP triggers; consider ongoing bleeding/response without waiting for 24-hour10-unit totals.
  4. 初始血浆:血小板:红细胞1:1:1–1:1:2（国内R27）后尽早目标导向。国内1 U红细胞通常来自200 mL全血，不可按国外1 unit原样计数；血小板按血库治疗量换算。Initial plasma:platelets:RBC 1:1:1–1:1:2 (Chinese R27), then early goal-directed therapy. Domestic RBC units generally derive from 200 mL whole blood and differ from overseas units; convert platelet therapeutic amounts with the blood bank.

ACS TQIP 大量输血指南ACS TQIP massive transfusion guidance · 中国休克共识2023Chinese shock2023 · 国家卫健委：临床用血技术规范（2025年版）NHC clinical blood use technical standard (2025)

以本院血库规范为准；数字需结合人群、阶段与来源。Follow institutional blood-bank policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

初始血浆:血小板:红细胞1:1:1–1:1:2（国内R27）后尽早目标导向。国内1 U红细胞通常来自200 mL全血，不可按国外1 unit原样计数；血小板按血库治疗量换算。以本院规范为准。Initial plasma:platelets:RBC 1:1:1–1:1:2 (Chinese R27), then early goal-directed therapy. Domestic RBC units generally derive from 200 mL whole blood and differ from overseas units; convert platelet therapeutic amounts with the blood bank. Follow institutional policy.

审核记录Review record

打开原课Open course

纤维蛋白原Fibrinogen

严重活动出血，或黏弹性检测提示功能性缺乏。Major active bleeding or viscoelastic evidence of functional deficit.

  1. Clauss Fib ≤1.5 g/L + 大出血。Clauss Fib ≤1.5 g/L + major bleeding.
  2. 欧洲R29首剂约3–4 g纤维蛋白原浓缩物，或按本院冷沉淀每U实际含量折算；国内U来源与国外不同，不能直接套15–20 U；输后复测。European R29 initial fibrinogen concentrate about 3–4 g, or cryoprecipitate by measured local content per unit; domestic and overseas units differ, so do not copy15–20 units directly; recheck.
  3. 出血持续、检测恶化：血库/凝血团队按本院方案升级。Ongoing bleeding/worsening tests: blood-bank/coagulation escalation.

欧洲出血2023European bleeding2023 · 国内围术期共识Chinese perioperative

以本院血库规范为准；数字需结合人群、阶段与来源。Follow institutional blood-bank policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

国内围术期共识：严重渗血冷沉淀条款为<1.5，纤维蛋白原条款为<1.5–2.0；场景及边界不同。Chinese perioperative consensus uses <1.5 for cryo in severe oozing and <1.5–2.0 for fibrinogen; scope/operators differ.

审核记录Review record

打开原课Open course

输血时 Hb 目标Hb target during transfusion

成人创伤，需要红细胞输注时的欧洲R16目标。European R16 target for adult trauma requiring RBC transfusion.

  1. Hb 70–90 g/L。Hb 70–90 g/L.
  2. 结合活动出血、灌注与病程；早期Hb正常不能排除大出血。Use bleeding/perfusion/trajectory; normal early Hb does not exclude hemorrhage.
  3. TBI、心肌缺血及特殊人群按专科目标；不等Hb下降才启动抢救。TBI, myocardial ischemia and special populations need specific goals; do not await Hb fall.

欧洲出血2023European bleeding2023 · 国家卫健委：临床用血技术规范（2025年版）NHC clinical blood use technical standard (2025)

以本院血库规范为准；数字需结合人群、阶段与来源。Follow institutional blood-bank policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

国内2025用血规范要求个体评估与输后评价，不能据其声称全国统一70–90目标。Chinese 2025 blood-use standard requires individual assessment/response review, not a national 70–90 target.

审核记录Review record

打开原课Open course

离子钙Ionized calcium

成人大出血，尤其大量输血。Adult major bleeding, especially massive transfusion.

  1. iCa≥1.00 mmol/L（国内）；欧洲正常范围1.1–1.3 mmol/L。iCa at least 1.00 mmol/L (Chinese); European normal1.1–1.3 mmol/L.
  2. 开始输血即测iCa；10%氯化钙10 mL约元素钙270 mg，10%葡萄糖酸钙10 mL约90 mg；补低钙时核对浓度、通路及复测。Measure iCa at transfusion start; 10 mL of10% calcium chloride contains about 270 mg elemental calcium, versus about 90 mg in10% calcium gluconate. Verify concentration/access and recheck.
  3. 输血仍在进行、iCa下降或心律变化：及时团队复评。Ongoing transfusion, falling iCa or rhythm changes: prompt reassessment.

欧洲出血2023European bleeding2023 · 国内围术期共识Chinese perioperative

以本院血库规范为准；数字需结合人群、阶段与来源。Follow institutional blood-bank policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

欧洲R31推荐氯化钙纠正低钙；上述为元素钙含量对照，不是两药逐毫升互换处方。国内R27下限与欧洲正常范围分开理解。European R31 prefers calcium chloride for hypocalcemia; this compares elemental content rather than interchangeable volume prescriptions. Distinguish the Chinese lower target from European normal range.

审核记录Review record

打开原课Open course

重型颅脑伤：灌注目标Severe TBI: perfusion target

重型TBI（GCS ≤8）；不能套用允许性低血压。Severe TBI (GCS ≤8); avoid permissive hypotension.

  1. MAP ≥80 mmHg。MAP ≥80 mmHg.
  2. GCS9–15且伤后≤3 h可按CRASH-3讨论TXA；TBI出血血小板目标>100×10⁹/L（欧洲R30）；创伤性ICH用TEG/ROTEM指导凝血纠正（NCS/SCCM2026）。For GCS 9–15 within three hours, discuss TXA by CRASH-3 scope; TBI bleeding platelet goal above100×10⁹/L (European R30); VHA-guided traumatic-ICH correction (NCS/SCCM2026).
  3. 意识/瞳孔变化、目标未达：同步纠正氧合/灌注并升级神经救治。Changing consciousness/pupils or unmet goals: address oxygenation/perfusion and escalate neurological care.

中国休克共识2023Chinese shock2023 · 中国院前共识2026Chinese prehospital2026 · 欧洲出血2023European bleeding2023 · CRASH-3CRASH-3 · NCS/SCCM2026NCS/SCCM2026

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

CRASH-3招募GCS≤12或CT证实颅内出血、无严重颅外出血；轻中度亚组结果不能推广为所有TBI获益。CRASH-3 enrolled GCS at most12 or CT-confirmed intracranial bleeding without major extracranial hemorrhage; subgroup benefit is not universal TBI benefit.

审核记录Review record

打开原课 1Open course 1 · 打开原课 2Open course 2

老年：提早警惕隐匿休克Older adults: occult shock warning

老年创伤高风险识别/分诊提示，不等于单独确诊休克。Older-trauma high-risk triage signal, not a stand-alone shock diagnosis.

  1. ≥65 岁；SBP <110 mmHg。Age ≥65; SBP <110 mmHg.
  2. ≥65岁SBP<110或HR>SBP提示风险；抗凝+头伤即使体征正常也升级评估。At least 65 years with SBP below 110 or HR above SBP raises concern; anticoagulated head injury escalates assessment even with apparently normal signs.
  3. 低能量伤合并症状、抗凝或灌注异常：提早高级评估。Low-energy injury with symptoms, anticoagulation or poor perfusion: early senior review.

中国院前共识2026Chinese prehospital2026 · 国家卫健委：老年髋部骨折诊疗与管理指南（2022年版）NHC geriatric hip fracture care and management guideline (2022)

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

110阈值源于重伤院前共识；髋部指南仅作国内骨科后续路径入口。The 110 signal comes from prehospital consensus; hip guidance is a domestic orthopedic pathway entry.

审核记录Review record

打开原课 1Open course 1 · 打开原课 2Open course 2

抗凝药：识别后逆转路径Anticoagulants: reversal pathway

危及生命/不可控出血或紧急高风险手术；由授权团队决策。Life-threatening/uncontrolled bleeding or urgent high-risk surgery; authorized team decisions.

  1. 危及生命出血：核对药物、末次剂量、INR/肾功能/抗Xa。Life-threatening bleeding: drug, last dose, INR/renal function/anti-Xa.
  2. 华法林：4F-PCC25–50 IU/kg按INR+维生素K₁5–10 mg缓慢静注；可及4F-PCC优于FFP。达比加群：依达赛珠单抗5 g静注。Xa药：可考虑4F-PCC25–50 IU/kg；ICH按2026条件性推荐优先4F-PCC。Warfarin: 4F-PCC 25–50 IU/kg by INR plus vitamin K1 5–10 mg slow IV; available 4F-PCC preferred to FFP. Dabigatran: idarucizumab5 g IV. Xa agents: consider4F-PCC 25–50 IU/kg; 2026 ICH conditional guidance favors4F-PCC.
  3. andexanet美商业销售已停止；欧盟/英国仍可条件获得，权衡获益不确定、血栓和费用。创伤性ICH抗血小板输注尚无统一推荐，不自动常规使用。US andexanet sales have ceased; conditional EU/UK availability requires benefit/thrombosis/cost review. Traumatic antiplatelet-associated ICH has no uniform platelet-transfusion recommendation; do not use automatically.

中国休克共识2023Chinese shock2023 · 国内围术期共识Chinese perioperative · 欧洲出血2023European bleeding2023 · FDA2025FDA2025 · ACEP2026ACEP2026 · NCS/SCCM2026NCS/SCCM2026 · BSH2026BSH2026

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

核对本院PCC三/四因子与标示单位、药品注册和可及性；4F不可及时按血库替代流程，不把FFP等同4F-PCC。与患方共同决策，监测血栓。 andexanet后72 h内血栓风险需重点观察。Check three/four-factor products, units, registration and availability; use local alternatives if4F is unavailable without equating FFP with4F-PCC. Shared decisions and thrombosis monitoring apply. Pay particular attention to early thrombosis within 72 hours after andexanet.

审核记录Review record

打开原课Open course

孕妇创伤：母体与产科并行Pregnancy trauma: maternal/obstetric care

体位处理：子宫至脐水平/以上；抗D：未致敏RhD阴性腹部/重大创伤，按孕周分支。Positioning: uterus at/above umbilicus; anti-D: unsensitised RhD-negative abdominal/major trauma, by gestation.

  1. 母体优先；子宫左推；Rh D。Mother first; left uterine displacement; Rh D.
  2. 未致敏RhD阴性孕妇腹部/重大创伤：72 h内给抗D，先给药不等检测结果。12⁺⁰–19⁺⁶周至少250 IU，无需FMH检测；≥20⁺⁰周至少500 IU，并做FMH（KB或流式）定量决定是否追加。核对本院抗D可及性与剂型。Unsensitised RhD-negative woman with abdominal/major trauma: give anti-D within 72 h without waiting for test results. 12+0–19+6 weeks: at least 250 IU, no FMH test needed; ≥20+0 weeks: at least 500 IU plus FMH quantification (Kleihauer or flow cytometry) to decide additional doses. Check local anti-D availability and formulation.
  3. ≥20周手推子宫或左倾15–30°；育龄女性查HCG（国内R20）；母体不稳定或胎心担心即创伤—产科升级。At ≥20 weeks use manual uterine displacement or left tilt 15–30°; test HCG when appropriate (Chinese R20); escalate maternal instability or fetal concern jointly.

Queensland妊娠创伤Queensland pregnancy · 中国休克共识2023Chinese shock2023 · BCSH抗D 2014BCSH anti-D 2014 · NHS抗D路径NHS anti-D pathway

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

英国BCSH路径：12⁺⁰–19⁺⁶周250 IU、≥20⁺⁰周500 IU并做FMH；Queensland创伤指南另建议RhD阴性≥13⁺⁰周做KB，不可混成同一规则。保留Queensland来源；本院产科/输血科选择一致路径。BCSH出版全文未直接读取，剂量由NHS公开实施路径核对；尚未核实国内等同条款。BCSH pathway: 250 IU at 12+0–19+6 weeks; 500 IU plus FMH at ≥20+0 weeks. Queensland trauma guidance separately recommends KB from 13+0 weeks in RhD-negative women. Keep these pathways distinct and agree one local obstetric/transfusion protocol. BCSH publisher full text was inaccessible; doses were checked against public NHS implementation. No equivalent Chinese clauses were verified.

审核记录Review record

打开原课Open course

孕妇心停：复苏性分娩Pregnancy arrest: resuscitative delivery

宫底达脐或以上（约≥20孕周）、标准复苏无ROSC；受训团队。Fundus at/above umbilicus (approximately at least 20 weeks), no ROSC with standard resuscitation; skilled team.

  1. 识别心停即准备；目标 ≤5 min 完成。Prepare at arrest recognition; goal delivery by ≤5 min.
  2. AHA2025：在心停现场组织产科/麻醉/新生儿团队与复苏性分娩。AHA 2025: organize obstetric/anesthetic/neonatal teams and resuscitative delivery at the arrest site.
  3. 4 min启动、5 min娩出仍是AHA 2025推荐时间目标；识别心停即呼叫准备，就地实施；超过5 min仍可能获益，不因超时放弃，并行处理创伤可逆原因。Four-minute initiation/five-minute birth remains the AHA 2025 timing goal; call/prepare at arrest recognition, perform on site; benefit may remain beyond five minutes, so do not abandon solely for delay; address traumatic causes.

AHA 2025AHA 2025 · Queensland妊娠创伤Queensland pregnancy

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

四/五分钟时点不意味着等待四分钟才呼叫、备器械或备新生儿救援；母体复苏与分娩准备并行。Four/five-minute timing does not justify waiting four minutes to call, prepare equipment or neonatal rescue; maternal resuscitation and delivery preparation are parallel.

审核记录Review record

打开原课Open course

儿童：体重与首轮复苏Children: weight and first aliquot

RCH儿童重大创伤，循环不足的首轮等渗液体评估；并行识别出血。RCH major pediatric trauma with poor circulation; assess bleeding in parallel.

  1. 实测/近期体重；晶体液 10 mL/kg。Measured/recent weight; crystalloid 10 mL/kg.
  2. 疑出血血流动力学受损：小量初始复苏并早用血；RCH初剂TXA15 mg/kg，上限与速度核对儿科药品方案。Suspected bleeding with compromise: small initial resuscitation aliquots and early blood; RCH initial TXA 15 mg/kg, with maximum/rate checked in the pediatric product protocol.
  3. 每份后复评；持续失血尽早血库/儿科MTP，不重复大量晶体液。Reassess each aliquot; ongoing hemorrhage needs blood-bank/pediatric MTP, avoiding repeated large crystalloids.

RCH：儿童重大创伤初评RCH: major pediatric trauma primary survey · WS/T795—2022WS/T795—2022

以本院儿科规范为准；数字需结合人群、阶段与来源。Follow institutional pediatric policy; check population, stage and source.2026-10-15
查适用差异、审核记录和原课Scope differences, review record and course

国内重症失血性休克成分方案见下一卡；常规RBC 10–15表不适用于急救大出血。Chinese major-hemorrhage component regimen is on the next card; routine RBC table excludes emergency major bleeding.

审核记录Review record

打开原课Open course

儿童：国内失血性休克输血索引Children: Chinese hemorrhagic transfusion index

WS/T795—2022 §9.5.2.2：儿童创伤性失血性休克。WS/T795—2022 §9.5.2.2: pediatric traumatic hemorrhagic shock.

  1. RBC : FFP = 1 : 1（容量）RBC : FFP = 1 : 1 (volume)
  2. 标准举例RBC 20 mL/kg + FFP 20 mL/kg；不是常规贫血或非创伤比例。Standard example: RBC 20 mL/kg + FFP 20 mL/kg; not routine anemia/non-trauma ratio.
  3. RBC累计>40 mL/kg可考虑PLT15–20 mL/kg+冷沉淀10 mL/kg；按化验目标Hb>80、Fib>1.5、APTT/PT<中点1.5倍、PLT>75×10⁹/L调整并监测超负荷。With cumulative RBC above40 mL/kg, consider platelets15–20 mL/kg and cryo10 mL/kg; adjust to Hb above80 g/L, Fib above1.5 g/L, APTT/PT below 1.5 times reference midpoint and PLT above75×10⁹/L; monitor overload.

WS/T795—2022WS/T795—2022 · 儿科输血解读2025Pediatric interpretation2025

以本院血库规范为准；数字需结合人群、阶段与来源。Follow institutional blood-bank policy; check population, stage and source.2026-10-15
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此为成分容量方案示例，与RCH首轮小份的阶段不同；核对产品规格和本院儿童流程。A component-volume regimen, at a different stage from RCH initial aliquots; check product/local pediatric policy.

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烧伤：中国新九分法Burns: Chinese rule of nines

头面颈、双上肢、躯干含会阴、双下肢含臀足。Head/face/neck; both arms; trunk including perineum; both legs including buttocks/feet.

  1. 成人：9 + 18 + 27 + 46 = 100%。Adult: 9 + 18 + 27 + 46 = 100%.
  2. 12岁以下：头面颈=9+(12−年龄)%；双下肢=46−(12−年龄)%。Under 12: head/neck=9+(12−age)%; both legs=46−(12−age)%.
  3. 静脉复苏评估：成人Ⅱ/Ⅲ度>15%、儿童>5%、老年>10%或Ⅲ度>5%；吸入伤与循环状态可独立升级。IV resuscitation assessment: adult partial/full-thickness over 15%, child over 5%, elder over 10% or full-thickness over 5%; inhalation injury/physiology may independently escalate.

卫健委烧伤规范2025NHC burns2025

以本院烧伤科规范为准；数字需结合人群、阶段与来源。Follow institutional burn-service policy; check population, stage and source.2026-10-15
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按2025版规范表1及§2.1；补液面积只计Ⅱ/Ⅲ度，不将Ⅰ度纳入。2025 standard Table 1 / §2.1; fluid-formula area uses second/third degree, excluding superficial burns.

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烧伤：国内成人补液公式Burns: Chinese adult fluid formula

国内2025规范晶胶混合公式；Ⅱ/Ⅲ度，%填百分数数值。Chinese 2025 crystalloid/colloid formula; second/third degree; enter percentage number.

  1. 首24 h：1.5–2 mL × kg × %TBSA + 2000 mL。First 24 h: 1.5–2 mL × kg × %TBSA + 2000 mL.
  2. 晶:胶=1–2:1；总估算量一半在伤后首8 h，余量分后两个8 h。Crystalloid:colloid=1–2:1; half estimated total in first eight hours from injury, quarters in next two intervals.
  3. 尿量0.5–1 mL/(kg·h)，电击/挤压/溶血性化学伤1–2；第二24 h晶胶减半、基础水分同首日；基础水分分配按烧伤科方案。Urine0.5–1 mL/(kg·h),1–2 for electrical/crush/hemolytic chemical injury; second-day crystalloid/colloid half first-day actual amount, maintenance unchanged; allocate maintenance per burn service.

卫健委烧伤规范2025NHC burns2025

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1.5是该版范围下限，不是唯一固定量；已输入液体计入总量，以本院烧伤流程为准。1.5 is the lower end, not a fixed universal amount; include prior fluids and follow local burn policy.

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抢救、告知与交接文书Resuscitation, consent and handover records

仅限因抢救急危患者未能及时书写；不是所有病历可延迟。Only when urgent rescue prevented timely writing; not permission to delay all records.

  1. 抢救结束后 ≤6 h 据实补记并注明。Truthful, marked supplementation ≤6 h after rescue ends.
  2. 时间到分钟；措施、反应、人员、告知与交接责任。Minute-level time, actions, responses, staff, communication and handover ownership.
  3. 签署困难记录原因并走合法授权/急救审批流程，不造签名或回填时间。Record signing difficulties and use lawful emergency authorization; never fabricate signatures/times.

病历书写基本规范（2010）Basic norms for medical record writing (2010) · 国家卫健委：临床用血技术规范（2025年版）NHC clinical blood use technical standard (2025)

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病历规范第22条(八)、25/27条；输血告知同步遵循2025用血规范。Record norms Article 22(8), 25/27; transfusion consent also follows 2025 blood-use standards.

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抢救室：到院前Trauma bay: before arrival

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 角色：床头 / 胸部 / 循环 / 记录。Roles: head / chest / circulation / recorder.
  2. 确认空间、监护、血库与高级支援。Confirm space, monitors, blood bank and senior support.
  3. 交接：机制、发现、已做、未知。Handover: mechanism, findings, actions, unknowns.
  4. 升级：立即威胁或资源不能覆盖需求。Escalate immediate threats or inadequate resources.

WHO 创伤救治核对单与团队交接WHO trauma care checklist and team handover · 中国院前共识2026Chinese prehospital2026

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xABCDE：每轮回看xABCDE: revisit each cycle

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. x出血 → A气道/保护 → B呼吸 → C循环 → D神经 → E暴露/保暖。x bleeding → A airway/protection → B breathing → C circulation → D neurology → E exposure/warmth.
  2. 具体事实 + 趋势 + 责任人。Specific findings + trends + owner.
  3. 措施后核查有效性，补齐未知区域。Check effect after actions; revisit unknown regions.
  4. 恶化：回到初评，同时升级。Deterioration: return to primary survey and escalate.

中国院前共识2026Chinese prehospital2026 · NICE NG39NICE NG39

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骨盆：并行识别风险Pelvis: parallel risk recognition

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. WSES：SBP<90，或需持续补液/输血/升压药维持；BD>6 mmol/L、SI>1或24 h需4–6 U RBC也是风险依据，单位不可跨国直接折算。WSES: SBP below 90 or maintained by ongoing fluids/blood/vasopressors; BD over 6, SI over 1 or4–6 RBC units in24 hours also indicate risk. Do not directly convert national component units.
  2. 骨盆带中心位于大转子/耻骨联合水平；无相关肢体禁忌时双膝并拢、踝内旋，避免反复挤压分离试验。同步血液、保温、TXA及其他出血源检查。Center the binder at greater trochanters/symphysis level; knees together and internal leg rotation when associated injuries allow. Avoid repeated springing. Coordinate blood, warming, TXA and other-source checks.
  3. 骨盆带→动脉出血且不需开腹：血管造影栓塞；需开腹/快速控制：腹膜外填塞+外固定。REBOA Zone III仅受训团队为疑盆腔来源、极不稳定者的过渡，不是所有路径的必经最后一步。Binder→arterial bleeding without laparotomy need: AE; laparotomy/rapid control need: preperitoneal packing plus external fixation. ZoneIII REBOA is a skilled-team bridge in extreme instability with suspected pelvic source, not a mandatory final step.

WSES骨盆2017WSES pelvic 2017 · NICE NG37NICE NG37 · 欧洲出血2023European bleeding2023 · 中国休克共识2023Chinese shock2023

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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救治链：跨节点不断线Care chain: continuity at transitions

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 先明确接收能力与负责人。Confirm destination capability and owner.
  2. 交接已知 / 未知 / 担心 / 下一次复评。Hand over knowns / unknowns / concerns / next review.
  3. 移动前核查监护、气道、出血与装备。Before movement check monitoring, airway, bleeding, equipment.
  4. 资源堵塞或患者变化：重新定去向。Bottleneck or patient change: reassess destination.

WHO 创伤救治核对单与团队交接WHO trauma care checklist and team handover · 中国院前共识2026Chinese prehospital2026

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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灾难：患者与系统双复评Disaster: patient and system review

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 行走先绿；开放气道仍无呼吸为黑；RR>30、无桡动脉/CRT>2 s、不能遵嘱任一为红；其余黄。初次标签仍需复评。Walking initially green; apnea after airway opening black; RR over 30, absent radial pulse/CRT over two seconds, or inability to obey commands red; otherwise yellow. Reassess initial tags.
  2. ERBP2012：尽早解救前等渗盐水，成人1000 mL/h、儿童15–20 mL/kg/h；2 h后成人不超过500 mL/h、儿童约10 mL/kg/h或更低。禁机械套用大出血/TBI/心肾衰者。ERBP2012: early pre-extrication saline, adult 1000 mL/h/child15–20 mL/kg/h; after two hours adult at most500/child about 10 mL/kg/h or lower. Do not mechanically apply to bleeding/TBI/cardiac-renal failure.
  3. 一级冲击波（肺/耳/空腔）；二级破片；三级抛掷撞击；四级烧伤/吸入/挤压等。爆震肺可迟至48 h出现表现；鼓膜破裂单独不能衡量重伤，也不能排除。Primary pressure wave(lung/ear/hollow organs), secondary fragments, tertiary displacement, quaternary burns/inhalation/crush. Lung signs may appear up to 48 hours; isolated eardrum rupture neither measures nor excludes serious injury.

START成人/HHSSTART adult/HHS · JumpSTART儿童/HHSJumpSTART pediatric/HHS · SALT/MUCC/HHSSALT/MUCC/HHS · 国家医疗救援预案2006Chinese medical-rescue plan2006 · ERBP挤压综合征2012ERBP crush2012

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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复苏：四项并行Resuscitation: parallel tasks

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 止血与资源调度。Hemorrhage control and resource coordination.
  2. 早期TXA / 血液 / 凝血监测。Early TXA / blood / coagulation monitoring.
  3. 保暖、iCa、灌注与措施后反应。Warmth, iCa, perfusion and response checks.
  4. 数字分别见成人/TBI口袋卡。See separate adult/TBI numerical cards.

中国休克共识2023Chinese shock2023 · 欧洲出血2023European bleeding2023

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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二次 / 三次：防漏诊Secondary / tertiary: prevent missed injury

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 稳定后：AMPLE + 从头到脚查体。After stabilization: AMPLE + head-to-toe exam.
  2. 标明未评区域、影像待定与限制。Mark unassessed regions, pending imaging and limits.
  3. 重复查体、核对正式报告，指派责任人。Repeat exam, reconcile final reports, assign ownership.
  4. 新症状/恶化先回xABCDE；不等下一班。New symptoms/deterioration: xABCDE review without waiting.

RCH：二次评估RCH secondary survey · WHO 创伤救治核对单与团队交接WHO trauma care checklist and team handover

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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特殊人群：先分组Special populations: identify group

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 老年：抗凝 / 低能量重伤 / 基线功能。Older adults: anticoagulation, serious low-energy injury, baseline.
  2. 儿童：体重 / 年龄 / 血液方案。Children: weight, age, blood protocol.
  3. 妊娠：母体优先 / 产科并行。Pregnancy: mother first, obstetric collaboration.
  4. 烧伤：深度 / 中国九分法 / 专科复评。Burns: depth, Chinese rule of nines, specialist review.

中国院前共识2026Chinese prehospital2026 · WS/T795—2022WS/T795—2022 · 卫健委烧伤规范2025NHC burns2025 · Queensland妊娠创伤Queensland pregnancy

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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交接：写得出，接得住Handover: record and accept

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 发现与时间；措施与反应。Findings/time; actions/response.
  2. 未知事项与复评期限。Unknowns and review deadlines.
  3. 告知 / 同意 / 接收者确认。Communication / consent / receiver confirmation.
  4. 抢救补记条件与6小时见文书卡。See record card for six-hour rescue supplementation.

病历书写基本规范（2010）Basic norms for medical record writing (2010) · 国家卫健委：临床用血技术规范（2025年版）NHC clinical blood use technical standard (2025)

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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骨盆MDT病例：分步复盘Pelvic MDT case: staged debrief

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 早期静脉抗生素，NICE开放骨折尽量伤后1 h内；会阴伤口保护、污染记录，疑直肠伤由受训者直肠指检，阳性行直肠镜。Early IV antibiotics; NICE open-fracture goal within one hour. Protect perineal wounds/document contamination; trained digital rectal assessment when rectal injury suspected, proctoscopy if positive.
  2. 清创/填塞与血液复苏并行；直肠/泌尿伤评估后选择粪便转流或耻骨上膀胱造瘘，不是所有患者常规。以下是教学路径，未在原记录确认的措施不标作已实施。Debridement/packing and blood resuscitation proceed together. Fecal diversion or suprapubic drainage depends on rectal/urinary injury, not routine for everyone. Proposed teaching pathways are not documented performed care.
  3. 原始生命体征、Hb/乳酸/BE不足，不生成看似真实的轨迹。另作模拟时须明确合成并与真实病例分离。Do not create a plausible real trajectory when original vitals/Hb/lactate/BE are missing. Any simulation must be distinctly synthetic.

WSES骨盆2017WSES pelvic 2017 · NICE NG37NICE NG37 · 中国休克共识2023Chinese shock2023

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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技能：从决定到复评Skills: decision to reassessment

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 判断时机 → 准备与授权 → 关键步骤。Timing → preparation/authorization → key steps.
  2. 效果核查 → 失败识别 → 求助升级。Effect checks → failure recognition → escalation.
  3. 0未做到 / 1提示后做到 / 2独立完整。0 absent / 1 after prompting / 2 complete independently.
  4. 只在监督下模拟；评分不等于临床授权。Supervised simulation; scores do not authorize practice.

NICE NG39NICE NG39

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颅脑：神经与ABC联动TBI: neurology with ABC

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 重型TBI：SBP≥100（50–69岁），≥110（15–49岁或>70岁）；国内MAP≥80 mmHg。CPP60–70 mmHg、ICP>22 mmHg需处理；BTF压力证据III级，ICP/CPP为IIB级。Severe TBI: SBP at least 100 at 50–69 years, at least 110 at 15–49 or over 70; Chinese MAP at least 80 mmHg. CPP60–70, treat ICP over 22; BTF pressure evidence LevelIII, ICP/CPP LevelIIB.
  2. 国内SpO₂至少90%、理想>95%；ACS目标≥94%。无颅内高压时PaCO₂/PetCO₂参考35–45 mmHg，休克时EtCO₂不能替代动脉血气。Chinese SpO₂ floor90%, ideally over 95%; ACS target at least 94%. Without intracranial hypertension, PaCO₂/PetCO₂ reference35–45 mmHg; shock invalidates assuming EtCO₂ equals arterial CO₂.
  3. 国内推荐22：伤后3 h内1 g缓慢静脉给药>10 min，随后1 g维持≥8 h。NICE：≥16岁、GCS≤12、无活动性颅外出血，伤后2 h内考虑2 g静脉单次，在影像前实施。Chinese recommendation 22: within three hours,1 g slow IV over ten minutes, then1 g over at least eight hours. NICE: age at least 16, GCS at most12, no active extracranial bleeding: consider a single2 g IV dose within two hours, before imaging.

国内成人颅脑共识2025Chinese adult TBI2025 · BTF重型颅脑第4版BTF severe TBI4 · NICE NG232NICE NG232

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胸部：双侧对照Chest: bilateral comparison

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 成人第4/5肋间、腋中线稍前；备选第2肋间锁骨中线。儿童第2肋间锁骨中线。针长≥8 cm、14G/10G为成人TCCC器材参考，按体型与器械选择。Adults: fourth/fifth interspace just anterior to midaxillary line; second interspace midclavicular alternative. Children: second midclavicular. At least 8 cm,14G/10G is an adult TCCC equipment reference; adjust to anatomy/device.
  2. 置管即刻引流>1500 mL，或>200 mL/h持续2–4 h（本站以WSES连续3 h为教学参考），或持续血流动力学不稳定：立即胸外科评估/手术；不因等待时限延误。Immediate chest-tube output >1500 mL, >200 mL/h for 2–4 h (this site uses WSES 3 h for teaching), or persistent hemodynamic instability: immediate thoracic surgical evaluation/operation; do not delay for the time threshold.
  3. 气胸8.5–24 Fr；稳定血胸EAST条件推荐14 Fr或更小猪尾管，WSES-AAST较大血胸倾向28–40 Fr；不稳定用大口径。两者人群不同，不能互换。Pneumothorax8.5–24 Fr; EAST conditionally supports14 Fr or smaller pigtails in stable hemothorax, while WSES-AAST favors28–40 Fr for larger hemothorax. Unstable patients need large-bore drainage; populations differ.

中国院前共识2026Chinese prehospital2026 · WSES-AAST胸部2025WSES-AAST thoracic2025 · EAST血胸2021EAST hemothorax2021 · EAST 2011：血胸持续引流与生理EAST 2011: hemothorax output and physiology

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腹部：保留隐匿出血担心Abdomen: consider occult bleeding

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. SBP<90 mmHg伴休克征，或维持压力需持续补液/输血/血管活性药：按不稳定路径评估。FAST阳性且对复苏无反应→直接手术/损伤控制止血；有反应且可安全监护才增强CT。SBP below 90 with shock signs, or pressure requiring ongoing fluids/blood/vasopressors, indicates instability. Positive FAST with no response goes directly to surgery/damage-control hemorrhage control; responders may have monitored contrast CT.
  2. BE应连同符号、乳酸与变化解释；不把WSES原文BE>−5单独当触发器，碱缺失BD与负BE不可混用。Interpret BE sign with lactate and trend; do not use the WSES printed BE greater than−5 as a stand-alone trigger or interchange BD with negative BE.
  3. WSES I：稳定AAST I–II；II：稳定AAST III；III：稳定AAST IV–V；IV：任何解剖级别但不稳定。WSES I: stable AAST I–II;II: stable AAST III;III: stable AAST IV–V;IV: unstable at any anatomic grade.

NICE NG39NICE NG39 · WSES肝损伤2020WSES liver2020 · WSES脾损伤2017WSES spleen2017

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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多发伤：全局排序Polytrauma: global priorities

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 教学新增EFAST：左胸膜无滑动、右侧有滑动、无明显心包液；结合左呼吸音减低、BP78/48，立即由受训团队减压/胸引并复评，不等CT。Synthetic EFAST addition: absent left pleural sliding, right sliding present, no clear pericardial fluid. With reduced left sounds and BP78/48, trained teams decompress/drain and reassess without CT delay.
  2. 到院SI126/86≈1.47、ABC≥2：启动本院大量输血路径评估，血液与源控制同步。Arrival SI126/86 about 1.47, ABC at least 2: activate assessment for the institutional massive-transfusion pathway while controlling the source.
  3. 大出血Fib≤1.5 g/L考虑补充；iCa欧洲1.1–1.3 mmol/L、国内≥1.00；已给Fib1.7/iCa1.05是复查点，不应冒充已达补充阈值。Major bleeding Fib at most1.5 g/L prompts replacement assessment; European iCa1.1–1.3 mmol/L, Chinese at least 1.00. Given Fib1.7/iCa1.05 prompt review, not false claims that every replacement threshold is crossed.

中国休克共识2023Chinese shock2023 · 欧洲出血2023European bleeding2023 · WSES-AAST胸部2025WSES-AAST thoracic2025

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腹部病例：用趋势复盘Abdominal case: debrief trends

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 原记录SBP67伴低氧，不能等58 mmHg再启动。相对心动过缓应询问β阻滞剂/抗凝药，但不能据此否认休克。FAST原始结果、年龄、Hb、乳酸、BE、GCS分项均保留未知。Original SBP 67 with hypoxemia warrants escalation before58. Relative bradycardia prompts beta-blocker/anticoagulant history but does not negate shock. Original FAST, age, Hb, lactate, BE and GCS components remain unknown.
  2. 条件练习：不稳定+FAST阳性且复苏无反应→直接损伤控制剖腹；疑盆腔来源同步骨盆带/填塞路径。血液优先、TXA时间核查；不得把条件设定写为原病历已完成。Conditional exercise: unstable positive FAST with no response→damage-control laparotomy; suspected pelvis→binder/packing pathway. Prioritize blood and check TXA timing; do not describe proposed care as performed.

NICE NG39NICE NG39 · 欧洲出血2023European bleeding2023 · WSES骨盆2017WSES pelvic 2017

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休克复评：改善了吗？Shock reassessment: improvement?

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 原FAST只记录腹腔/胸膜阴性，不能视为心包阴性；剑突下心包窗、泵功能与右心负荷应在持续休克早期补查，不等第8轮。Hb数值及CT是否增强未在源资料确认，保留未知。Original FAST records negative abdomen/pleura, not a negative pericardium. Add subxiphoid view, pump function and right-heart assessment early in persistent shock, not at round8. Hb and contrast-CT status are unconfirmed.
  2. 疑出血以血制品为主、限制晶体；无重型TBI未止血期SBP80–90 mmHg为参考。不是将原病历“加压补液”改写成已输血。For suspected hemorrhage prioritize blood, limit crystalloid; SBP 80–90 is a reference before control without severe TBI. Do not rewrite original pressurized fluid as confirmed transfusion.
  3. 过敏性反应伴低压/呼吸受损：成人肾上腺素0.5 mg IM，必要时5 min重复，按本院过敏急救流程。AMPLE的A询问过敏；糖皮质激素后改善不能证明病因或替代一线肾上腺素。Anaphylaxis with circulatory/respiratory compromise: adult adrenaline0.5 mg IM, repeat after five minutes if needed per local pathway. AMPLE A asks allergies; improvement after steroids neither proves causality nor substitutes first-line adrenaline.

中国休克共识2023Chinese shock2023 · 欧洲出血2023European bleeding2023 · RCUK 特殊情况复苏指南（2025）RCUK special-circumstances resuscitation (2025)

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颈椎与髋：神经血管复查Spine/hip: neurovascular recheck

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 双上肢烧灼痛/运动异常而下肢相对保留：考虑中央脊髓综合征，补ASIA/ISNCSCI运动感觉及骶段检查，不凭症状确诊。弹射/感觉异常为高危：全程SMR、CT；有脊髓神经异常则CT后MRI。Bilateral arm burning pain/weakness with relative leg sparing raises central-cord concern. Complete ASIA/ISNCSCI motor/sensory/sacral assessment, not symptom-only diagnosis. Ejection/paresthesia are high risk: SMR and CT, then MRI for cord abnormalities.
  2. 尽早、常以伤后6 h内为研究比较目标，不能等待至6 h；复位前后记录坐骨神经及腓总支、血运，复位后CT查骨折/游离体/同心复位，随访股骨头坏死。Reduce urgently; six hours is a research comparison reference, not permission to wait. Document sciatic/peroneal function and perfusion before/after; post-reduction CT assesses fracture/fragments/congruence, followed by AVN surveillance.
  3. 镇静减轻痛苦但须独立监护、波形CO₂、复苏与气道救援准备，维持SMR并说明麻醉/骨科角色。ACEP2026强调容量不足者在可行时先纠正。Sedation needs dedicated monitoring, waveform CO₂, resuscitation/airway rescue and maintained SMR with anesthesia/orthopedic roles. ACEP2026 recommends correcting volume depletion first where feasible.

NICE NG41NICE NG41 · NICE NG37NICE NG37 · 髋脱位复位时点研究2017Hip reduction timing2017 · ACEP程序镇静2026ACEP sedation2026

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骨科：先全身后局部Orthopedics: systemic then local

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 尽早静脉抗生素，尽量伤后1 h内。国内2019 Gustilo I–II以一代头孢（原文头孢唑啉）为基础；III加氨基糖苷，粪便/厌氧污染加青霉素或甲硝唑；过敏/肾功能及本地耐药谱决定替代。Early IV antibiotics, ideally within one hour. Chinese 2019 GustiloI–II first-generation cephalosporin(cefazolin), III adds aminoglycoside, fecal/anaerobic contamination adds penicillin/metronidazole; allergy/renal function/local resistance guide alternatives.
  2. 高风险每小时查体，记录疼痛/被动牵拉痛及镇痛剂量；有症状松解环形层至皮肤，心脏水平，30 min内复评并即时骨科会诊。High risk: hourly exam, pain/passive stretch/analgesic dose. Symptoms: release circumferential layers to skin, heart-level limb, reassess within 30 minutes and consult orthopedics immediately.
  3. 无脉、持续出血、扩张性血肿为硬征；毛细血管再充盈或Doppler不能单独排除。立即骨科/血管/整形协同，必要时临时分流。Absent pulse/ongoing bleeding/expanding hematoma are hard signs; CRT/Doppler alone cannot exclude injury. Immediate orthopedic/vascular/plastic coordination, temporary shunt when needed.

中国开放骨折2019Chinese open fracture2019 · BOAST开放骨折2017BOAST open fracture2017 · NICE NG37NICE NG37 · BOAST筋膜室2025BOAST compartment2025 · BOAST血管2026BOAST arterial2026

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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脊柱：保护与动态神经查体Spine: protection and serial neurology

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. MAP主动增压下限75–80、上限90–95 mmHg，维持3–7天；弱推荐、极低质量证据。不是所有人的自然血压超过95都必须降压，区别重型TBI目标。Active MAP augmentation lower limit75–80/upper90–95 mmHg for 3–7 days, weak recommendation/very-low evidence. Do not lower every spontaneous pressure above95; distinguish severe-TBI targets.
  2. 可行时伤后24 h内减压，神经体征与CT后MRI、完整ASIA/骶段检查同步。When feasible decompress within 24 hours; combine neurologic findings, CT-then-MRI, complete ASIA/sacral assessment.
  3. AANS/CNS2013不推荐常规甲泼尼龙；AO2017仅弱建议成人伤后8 h内开始24 h输注作为选项，>8 h或48 h输注不建议。收益/感染等风险由专科与本院方案决定。AANS/CNS2013 discourages routine MPSS; AO2017 weakly offers adult 24-hour infusion starting within eight hours as an option, not after eight or48-hour infusion. Specialists/local policy weigh benefit/infection risk.

AO/Praxis脊髓2024AO/Praxis SCI2024 · AO脊髓激素2017AO SCI steroid2017 · NICE NG41NICE NG41

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上肢：前后对照查体Upper limb: pre/post comparison

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 肱骨髁上骨折/肘脱位：记录桡动脉、指端灌注及正中（含骨间前）、桡、尺神经运动与感觉；复位前后逐项对照（BOAST）。Supracondylar fracture/elbow dislocation: document radial pulse, digital perfusion and median (including AIN), radial and ulnar motor/sensory findings before and after reduction (BOAST).
  2. 肱骨干骨折：复位前后记录伸腕/伸指及虎口背侧感觉；新桡神经缺损立即升级，不能只凭复位片满意结束（BOAST神经血管原则）。Humeral shaft fracture: record wrist/finger extension and dorsal first-web sensation before/after reduction. Escalate new radial deficits despite satisfactory alignment (BOAST neurovascular principles).
  3. 前臂高风险：持续疼痛、被动牵拉痛或感觉变化即复评；松解环形束缚、肢体心脏水平，立即骨科评估（BOAST筋膜室）。Forearm risk: worsening pain, passive-stretch pain or sensory change requires reassessment; release constriction, keep at heart level and obtain urgent orthopedic review (BOAST compartment guidance).
  4. 上肢用BBI/API（不是踝指数）；<0.9或脉搏不对称，稳定者CTA/血管外科评估；硬征或缺血不等指数/CTA延误救治（WTA/BOAST）。Use upper-limb BBI/API rather than an ankle index; below 0.9 or asymmetric pulses warrants CTA/vascular review if stable. Hard signs or ischemia require immediate care without waiting for indices/imaging (WTA/BOAST).

BOAST：儿童肱骨髁上骨折BOAST: pediatric supracondylar humerus · BOAST血管2026BOAST arterial2026 · BOAST筋膜室2025BOAST compartment2025 · WTA：肢体血管伤API/BBIWTA: extremity vascular API/BBI

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下肢：局部与全身风险Lower limb: local and systemic risk

分层课程速记；规培关键步骤与模拟须有监督，按本院流程。Tiered recall; resident key-step simulation requires supervision and local policy.

  1. 膝脱位（包括自行复位）：复位前后查血管与腓总神经，测ABI；<0.9或脉搏不对称行CTA/血管外科评估。≥0.9仍需序贯查体，不能只因有脉搏排除（BASK）。Knee dislocation, including spontaneously reduced injury: assess vessels/peroneal nerve and ABI before/after reduction. Below 0.9 or asymmetric pulses requires CTA/vascular review. Serial examinations remain necessary at ≥0.9 (BASK).
  2. 股骨干牵引夹板仅用于适合的孤立股骨干伤；合并骨盆、同侧膝/小腿/踝损伤避免牵引，先选其他固定并核对装置（院前共识/技能规范）。Traction splints suit selected isolated femoral shaft injuries; avoid traction with pelvic or ipsilateral knee/lower-leg/ankle injury. Use alternative stabilization and verify device rules (prehospital guidance).
  3. 胫骨骨折为筋膜室高风险：序贯疼痛、牵拉痛、感觉/运动及镇痛量；疑诊立即松解束缚与骨科评估，脉搏存在不排除（BOAST）。Tibial fractures carry compartment risk: serial pain/stretch, sensory/motor and analgesic-dose assessment. Release constriction and obtain urgent orthopedic review when suspected; pulses do not exclude it (BOAST).
  4. 老年髋部骨折走老年共管路径；NICE入院当天或次日手术，国内48 h目标需完成必要优化，神经阻滞不替代早期手术（NICE/国内实施依据）。Older hip-fracture patients need a geriatric co-care pathway: NICE surgery on admission day/next day; the Chinese 48-hour goal requires necessary optimization. Nerve blocks do not replace early surgery (NICE/Chinese implementation evidence).

BASK：膝多韧带损伤/脱位标准BASK: multiligament knee injury/dislocation · EAST 2012：穿透性下肢动脉伤EAST 2012: penetrating lower-limb arterial trauma · BOAST血管2026BOAST arterial2026 · 中国院前共识2026Chinese prehospital2026 · BOAST筋膜室2025BOAST compartment2025 · NICE CG124NICE CG124 · 国内髋部48h官方实施说明Chinese hip48 h official implementation

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球囊面罩：技能口袋卡Bvm: skill pocket

监督下模型训练；真实操作按本院授权与技能课来源。Supervised trainer practice; real procedures follow authorization and skill sources.

  1. 评估呼吸/保护反射与SMR，吸引血液/分泌物；无禁忌选择口/鼻咽通气道。Assess breathing/protection/SMR, suction blood/secretions, choose appropriate oral/nasal adjunct without contraindications.
  2. 双人双手扣面罩并托下颌，助手挤球囊，以可见胸廓起伏和漏气核查。Two-person two-hand seal/jaw support; assistant bags, checking chest rise and leak.
  3. 氧合/胸廓无改善查密闭、阻塞、体位及胸部原因；持续失败升级高级气道，记录SpO₂/EtCO₂及灌注。If oxygen/chest rise fails check seal, obstruction, position and chest causes; persistent failure escalates airway with SpO₂/EtCO₂/perfusion review.
  4. OSCE 0未做/不安全、1提示后完成、2独立完成；满分10，关键失败否决。OSCE 0 omitted/unsafe,1 prompted,2 independent; total 10, critical failure overrides.

BTS 成人急救氧疗指南（2017）BTS emergency oxygen guideline (2017) · RCUK 特殊情况复苏指南（2025）RCUK special-circumstances resuscitation (2025) · NICE NG41NICE NG41 · AHA成人BLS2025AHA adult BLS2025

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插管：技能口袋卡Intubation: skill pocket

监督下模型训练；真实操作按本院授权与技能课来源。Supervised trainer practice; real procedures follow authorization and skill sources.

  1. DAS成人视频喉镜首选；SMR/MILS按颈椎损伤场景，吸引、B/C/D失败计划和角色明确。DAS adult video laryngoscopy first; use trauma-specific SMR/MILS, suction, B/C/D backup plans and assigned roles.
  2. JTS严重失血麻醉参考减量滴定：氯胺酮约1 mg/kg IV，丙泊酚0.5–1 mg/kg IV可降压；不是所有患者默认方案。按本院麻醉医师评估。JTS severe-hemorrhage anesthesia references reduced/titrated ketamine about 1 mg/kg IV, propofol0.5–1 mg/kg IV with hypotension risk, not default doses for everyone; local anesthesia assessment.
  3. 持续波形CO₂确认后固定，查深度、双肺、SpO₂、血压；移动后再确认，失败进入DAS救援。Confirm with sustained waveform CO₂, secure and check depth/bilateral lungs/SpO₂/pressure; reconfirm after movement, enter DAS rescue on failure.
  4. OSCE 0未做/不安全、1提示后完成、2独立完成；满分10，关键失败否决。OSCE 0 omitted/unsafe,1 prompted,2 independent; total 10, critical failure overrides.

DAS困难插管2025DAS intubation2025 · JTS创伤麻醉2021/2023JTS trauma anesthesia2021/2023 · NICE NG41NICE NG41

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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紧急颈前气道：技能口袋卡Cricothyrotomy: skill pocket

监督下模型训练；真实操作按本院授权与技能课来源。Supervised trainer practice; real procedures follow authorization and skill sources.

  1. DAS成人#10刀片、bougie、6.0 mm套囊管，充分肌松、吸引；原指南最大伸颈为成人困难气道场景，创伤疑颈椎伤须权衡氧合救命与SMR，不能常规强行伸颈。DAS adult #10 scalpel, bougie,6.0 mm cuffed tube, full paralysis/suction. Maximal extension belongs to its adult difficult-airway context; suspected trauma spine injury requires oxygen-rescue/SMR judgment, not routine forced extension.
  2. DAS 2015可触及：横向刺切皮肤和环甲膜，刀垂直转90°使刃朝足侧，bougie入气管，导引6.0 mm套囊管。DAS 2015 palpable membrane: transverse stab through skin/membrane; turn the perpendicular blade 90° caudally, insert bougie and guide a 6.0 mm cuffed tube.
  3. DAS 2015不可触及：中线自尾向头纵切8–10 cm，手指钝分辨认后同上。DAS 2025更新为统一纵切路径、最长8 cm；训练前选定版本，不混称。DAS 2015 impalpable membrane: midline 8–10 cm caudal-to-cephalad incision, finger dissection/identification, then the same steps. DAS 2025 updates to a uniform vertical approach up to 8 cm; choose the training version explicitly.
  4. 持续波形CO₂确认并固定；OSCE 0/1/2、满分10，关键失败否决。Confirm sustained waveform CO₂ and secure; OSCE 0/1/2, total 10, critical failure overrides.

DAS 2015：可触及/不可触及环甲膜路径DAS 2015: palpable/impalpable membrane pathways · DAS困难插管2025DAS intubation2025 · NICE NG41NICE NG41

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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胸部减压：技能口袋卡Needle Decompression: skill pocket

监督下模型训练；真实操作按本院授权与技能课来源。Supervised trainer practice; real procedures follow authorization and skill sources.

  1. 成人第4/5肋间腋中线稍前；备选第2肋间锁骨中线，不在乳头线内侧；儿童第2肋间锁骨中线。Adult fourth/fifth interspace just anterior to midaxillary; alternate second midclavicular, not medial to nipple; child second midclavicular.
  2. 成人TCCC14G/10G、约8 cm（3.25英寸）导管参考；体型/器材按本院，沿下位肋骨上缘垂直进针，避免肋间血管神经。Adult TCCC 14G/10G, about 8 cm(3.25 inches) catheter reference; local anatomy/device selection, perpendicular over superior border of the lower rib.
  3. 仍无效或院内有熟练团队，转开放/手指胸廓造口并接胸管；TCCC院前第二次后路径与院内资源不同，不混称同一算法。Persistent failure or skilled hospital setting: open/finger thoracostomy then drain; TCCC post-second-attempt field care differs from the hospital pathway.
  4. OSCE 0未做/不安全、1提示后完成、2独立完成；满分10，关键失败否决。OSCE 0 omitted/unsafe,1 prompted,2 independent; total 10, critical failure overrides.

TCCC 2024TCCC 2024 · 中国院前共识2026Chinese prehospital2026 · NICE NG39NICE NG39 · WSES-AAST胸部2025WSES-AAST thoracic2025

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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胸腔引流：技能口袋卡Tube Thoracostomy: skill pocket

监督下模型训练；真实操作按本院授权与技能课来源。Supervised trainer practice; real procedures follow authorization and skill sources.

  1. 第4–6肋间腋前至腋中线安全三角，按患者影像/解剖确认；受训者钝性分离、手指确认胸膜入口，避免盲用套管针。Fourth–sixth interspace anterior-to-midaxillary safe triangle, confirm patient anatomy/imaging; trained blunt dissection/finger confirmation, no blind trocar.
  2. 气胸8.5–24 Fr；稳定血胸EAST条件支持14 Fr猪尾，较大/不稳定血胸WSES28–40 Fr（>32未见额外优势）。Pneumothorax8.5–24 Fr; stable hemothorax EAST conditional14 Fr pigtail, larger/unstable WSES 28–40 Fr(no added benefit above32).
  3. 置管即刻引流>1500 mL，或>200 mL/h持续2–4 h（本站以WSES连续3 h为教学参考），或持续血流动力学不稳定：立即胸外科评估/手术；不因等待时限延误。Immediate chest-tube output >1500 mL, >200 mL/h for 2–4 h (this site uses WSES 3 h for teaching), or persistent hemodynamic instability: immediate thoracic surgical evaluation/operation; do not delay for the time threshold.
  4. OSCE 0未做/不安全、1提示后完成、2独立完成；满分10，关键失败否决。OSCE 0 omitted/unsafe,1 prompted,2 independent; total 10, critical failure overrides.

WSES-AAST胸部2025WSES-AAST thoracic2025 · EAST血胸2021EAST hemothorax2021 · NICE NG39NICE NG39 · EAST 2011：血胸持续引流与生理EAST 2011: hemothorax output and physiology

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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EFAST：技能口袋卡Efast: skill pocket

监督下模型训练；真实操作按本院授权与技能课来源。Supervised trainer practice; real procedures follow authorization and skill sources.

  1. 双侧胸膜查滑动/肺点及积液；阴性或无滑动各有鉴别，不能单图诊断。Bilateral pleura: sliding/lung point/fluid; negative/absent sliding have alternatives, not a single-image diagnosis.
  2. 报窗口、图像质量、看见什么、哪些未完成与检查时点。Report windows/quality/findings/missing views/time.
  3. 重复观察与临床生理匹配；有反应稳定者增强CT，疑张力即减压不等超声完成。Repeat matched to physiology; monitored stable responders get contrast CT, suspected tension is treated without completing ultrasound first.
  4. OSCE 0未做/不安全、1提示后完成、2独立完成；满分10，关键失败否决。OSCE 0 omitted/unsafe,1 prompted,2 independent; total 10, critical failure overrides.

NICE NG39NICE NG39 · RCH：儿童重大创伤初评RCH: major pediatric trauma primary survey · WSES骨盆2017WSES pelvic 2017

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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止血带：技能口袋卡Tourniquet: skill pocket

监督下模型训练；真实操作按本院授权与技能课来源。Supervised trainer practice; real procedures follow authorization and skill sources.

  1. 已见伤口：TCCC近心端5–7 cm、非关节；国内共识≥10 cm按所选体系。不明部位高而紧；无效再紧固并加第二条并排/近端。Visible wound: TCCC 5–7 cm proximal, off a joint; Chinese reference at least 10 cm per selected system. If unseen, high-and-tight; tighten/add a second alongside/proximal if ineffective.
  2. 成功同时确认出血停止和远端脉搏消失（截肢不适用远端脉搏）；不能只看脉搏。Confirm both bleeding cessation and absent distal pulse, with pulse not applicable to amputation; pulse alone is insufficient.
  3. 尽力2 h内转加压/止血敷料，须无休克、可严密观察、非截肢；>6 h缺监护/化验不松解。仅受训团队转换。Aim for conversion within two hours only without shock, with close monitoring, and not amputation; after six hours do not remove without monitoring/labs. Trained team conversion only.
  4. OSCE 0未做/不安全、1提示后完成、2独立完成；满分10，关键失败否决。OSCE 0 omitted/unsafe,1 prompted,2 independent; total 10, critical failure overrides.

TCCC 2024TCCC 2024 · 中国院前共识2026Chinese prehospital2026 · 中国休克共识2023Chinese shock2023

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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骨盆束带：技能口袋卡Pelvic Binder: skill pocket

监督下模型训练；真实操作按本院授权与技能课来源。Supervised trainer practice; real procedures follow authorization and skill sources.

  1. 中心定位大转子和耻骨联合水平，不是髂嵴或腰；先核查衣物和皮肤。Center at greater trochanters/symphysis, not iliac crest/waist; check clothing/skin.
  2. 无伴随肢体禁忌时双膝并拢、踝内旋；只做温和观察，不反复弹性分离。Knees together/internal rotation when associated injuries allow; gentle observation, no repeated springing.
  3. 持续不稳定转AE/PPP及固定，建立移除替代方案，NICE24 h内去除且不稳定先与外科计划。Persistent instability→AE/PPP/stabilization; plan removal/replacement, NICE within 24 hours with surgical plan for instability.
  4. OSCE 0未做/不安全、1提示后完成、2独立完成；满分10，关键失败否决。OSCE 0 omitted/unsafe,1 prompted,2 independent; total 10, critical failure overrides.

WSES骨盆2017WSES pelvic 2017 · NICE NG37NICE NG37 · 中国休克共识2023Chinese shock2023

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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临时固定：技能口袋卡Splinting: skill pocket

监督下模型训练；真实操作按本院授权与技能课来源。Supervised trainer practice; real procedures follow authorization and skill sources.

  1. 开放骨折尽早1 h内静脉抗生素，盐水湿敷+封闭层，按授权拍照，急诊不冲洗、不探查；破伤风按本院。Open fracture: early IV antibiotics within one hour, saline-moistened/occlusive dressing, authorized photo, no ED irrigation/probing; local tetanus policy.
  2. 股骨干牵引夹板仅按装置与伤型；合并骨盆、同侧膝/小腿/踝损伤避免牵引，选普通固定。Femoral-shaft traction depends on device/pattern; avoid with pelvis or ipsilateral knee/lower-leg/ankle injury, use other immobilization.
  3. 疑筋膜室：松解环形包扎/夹板至皮肤，肢体心脏水平、立即骨科评估，不能因有脉搏排除。Suspected compartment syndrome: release circumferential dressings/splint to skin, limb at heart level, immediate orthopedics; a pulse does not exclude it.
  4. OSCE 0未做/不安全、1提示后完成、2独立完成；满分10，关键失败否决。OSCE 0 omitted/unsafe,1 prompted,2 independent; total 10, critical failure overrides.

NICE NG37NICE NG37 · NICE NG41NICE NG41

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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低体温与损伤控制Hypothermia and damage control

成人创伤大出血；测食管、膀胱或鼻咽等核心温度Adult major traumatic bleeding; use a core-temperature method

  1. 核心体温<35 ℃；复温目标36–37 ℃。Core below 35 C; rewarm toward36–37 C.
  2. 到院即去湿衣、保暖、加温毯及输液/血液加温；37 ℃实验室检测可能低估低温凝血障碍。Remove wet clothing, insulate and warm patient/infusions/blood;37 C laboratory testing may understate hypothermic coagulopathy.
  3. T≤35 ℃合并pH≤7.2、凝血病、持续出血和长重建手术风险：考虑分期损伤控制手术。T at most35 C with pH at most7.2, coagulopathy, ongoing bleeding and lengthy-reconstruction risk: consider staged damage-control surgery.

中国休克共识2023Chinese shock2023 · 欧洲出血2023European bleeding2023

以本院规范为准；数字需结合人群、阶段与来源。Follow institutional policy; check population, stage and source.2026-10-15
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国内R12/R29；不是用一个体温数字单独决定手术Chinese R12/R29; one temperature does not decide surgery alone

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儿童烧伤补液Pediatric burn fluids

儿童；基础水分70–100 mL/kg，<2岁100–150 mL/kgChildren; maintenance 70–100 mL/kg, under two years100–150 mL/kg

  1. 首24 h：2 mL×kg×%TBSA（Ⅱ/Ⅲ度）+基础水分。First24 hours:2 mL×kg×%TBSA (partial/full thickness)+maintenance.
  2. 晶:胶1–3:1；1/2伤后首8 h，余量分后两个8 h；尿量约1 mL/(kg·h)。Crystalloid:colloid1–3:1; half in first eight hours from injury, remainder in the next two eight-hour periods; urine about 1 mL/(kg·h).
  3. >5%可出现休克；头面颈伤警惕气道，按已输入量、循环和血糖动态调整。Over5% may cause shock; head/face/neck injury raises airway concern; adjust to previous fluids, circulation and glucose.

卫健委烧伤规范2025NHC burns2025

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不使用成人2000 mL基础水分；用实际体重和面积百分数数值Do not use adult 2000 mL maintenance; use actual weight and percentage-number area

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