TMTraumaMaster Academy

课堂学习 · 2026-10 更新Classroom learning · October 2026 update

特殊人群与烧伤Special populations and burns

保持共同的初评语言，同时主动询问哪些患者不能简单套用普通成人路径。Keep a shared assessment framework while identifying who needs a different pathway.

来源与审核记录Sources and review record
Conceptual teaching illustration, not case evidence
教学示意，非病例影像。Teaching illustration, not case imaging.

预计学习Estimated learning time · 30 分钟min

学完这门课，你能……After this course, you can…

  1. 识别老年创伤中的抗凝、脆弱性和低能量重伤风险。Recognize anticoagulation, frailty and low-energy serious injury in older adults.
  2. 区分儿童、妊娠与成人常规评估的适用条件。Distinguish pediatric and pregnancy assessment from routine adult assessment.
  3. 根据烧伤类型与吸入损伤担心组织专科协作。Coordinate specialist review by burn type and possible inhalation injury.
实习：识别与报告；规培：决策时机与监督下关键步骤；青年主治：团队指挥与资源调度。Intern: recognize/report; resident: decision timing and supervised key steps; early attending: team leadership and resources.
先做 5 题前测Start five-question pretest学完做 5 题后测Complete five-question posttest本课口袋卡Course pocket card
课前测 · 5 题Pretest · five questions

每题 1 分；用于形成性反馈。One point per item; formative feedback.

合成情境题Synthetic vignette 1. 72岁男性平地跌倒后髋痛，服用β阻滞剂，HR88次/min、BP108/64 mmHg、SpO₂95%。患肢短缩外旋、皮肤湿冷，家属称既往血压较高，尚无Hb结果，不能只依据低能量机制分流。下一步最合适的是？A 72-year-old man has hip pain after a standing fall and takes a beta blocker; HR 88/min, BP 108/64 mmHg, SpO₂ 95%. The limb is shortened/externally rotated and skin is clammy; baseline BP is higher, Hb is pending and low-energy mechanism may be misleading. What is the most appropriate next step?
合成情境题Synthetic vignette 2. 29岁女性孕24周，车祸后仰卧，HR132次/min、BP86/54 mmHg、SpO₂92%。腹部压痛、子宫高于脐，平卧时头晕加重，无明显外出血；创伤与产科团队正在并行评估。下一步最合适的是？A 29-year-old woman at 24 weeks lies supine after a collision; HR 132/min, BP 86/54 mmHg, SpO₂ 92%. She has abdominal tenderness, uterus above the umbilicus and worse supine dizziness without obvious external bleeding; trauma and obstetric teams are assessing in parallel. What is the most appropriate next step?
3. 儿童疑出血循环受损，RCH初始液体索引？RCH initial fluid index for a child with suspected bleeding/compromise?
4. 成人中国新九分法双上肢面积是多少？Adult Chinese rule-of-nines area of both upper limbs?
合成情境题Synthetic vignette 5. 28岁女性孕14周，交通伤后腹部压痛，HR96次/min、BP118/72 mmHg、SpO₂97%。母体循环稳定、未致敏RhD阴性，受伤后2 h；本院按英国路径且制剂可用，KB结果尚未回报。下一步最合适的是？A 28-year-old woman at 14 weeks has abdominal tenderness after a collision; HR 96/min, BP 118/72 mmHg, SpO₂ 97%. She is stable, unsensitised and RhD-negative 2 h after injury; the local service uses the BCSH pathway and anti-D is available, with KB results pending. What is the most appropriate next step?
Conceptual teaching illustration
教学示意：用于理解任务与关系。Conceptual illustration of tasks and relationships.

01

老年创伤：机制轻，风险未必轻Older adults: low energy does not ensure low risk

  • 补问抗凝/抗血小板用药、基础功能、脆弱性与既往疾病。Clarify anticoagulant/antiplatelet medicines, baseline function, frailty and comorbidity.
  • 低能量跌倒仍可能重伤；体征不典型或心率反应被药物影响时保留担心。Low-energy falls may cause serious injury; retain concern when signs are atypical or medicines alter heart-rate response.
  • 把延迟症状、镇痛与三次评估安排交给明确责任人。Assign ownership for delayed symptoms, analgesia and tertiary review.
Conceptual teaching illustration
教学示意：用于理解任务与关系。Conceptual illustration of tasks and relationships.

02

儿童与妊娠：关注各自的生理Children and pregnancy: physiology changes the assessment

  • 儿童按年龄、体重及儿科规范解读生理，并兼顾保暖、家庭沟通和保护。Interpret pediatric physiology by age/weight and pediatric policy, including warmth, family communication and safeguarding.
  • 孕妇优先母体复苏，及早创伤-产科协作，结合孕周与症状评估母胎风险。Prioritize maternal resuscitation and early trauma-obstetric collaboration, assessing gestation and maternal/fetal concerns.
  • 成人剂量、血压目标和影像路径不能自动移植；按对应来源与本地方案学习。Do not automatically transfer adult doses, BP targets or imaging pathways; use population-specific sources and local policy.
Conceptual teaching illustration
教学示意：用于理解任务与关系。Conceptual illustration of tasks and relationships.

03

烧伤：面积之外，还看什么Burns: what matters beyond visible area

  • 并行查看创伤、吸入损伤担心、深度、关键部位与疼痛。Assess associated trauma, possible inhalation injury, depth, key sites and pain in parallel.
  • 化学/电伤、儿童烧伤及合并伤可需要烧伤专科咨询；避免只凭外观排除风险。Chemical/electrical, pediatric and associated injuries may require burn consultation; appearance alone does not exclude risk.
  • 记录损伤方式、可核查面积/深度、呼吸变化和转运资源，按本地烧伤流程升级。Record mechanism, assessed area/depth, respiratory changes and transfer resources, escalating under local burn policy.

分组查阅：各自的数字与升级点By population: anchors and escalation

具体方案；以本院为准；每项数字同时核对人群、阶段和来源。Follow institutional protocols; check population, stage and source with every number.

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

≥65 岁；SBP <110 mmHg以本院规范为准。Age ≥65; SBP <110 mmHg Follow institutional policy.

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.

≥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。以本院规范为准。At least 65 years with SBP below 110 or HR above SBP raises concern; anticoagulated head injury escalates assessment even with apparently normal signs. Follow institutional policy.

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.

中华医学会相关学组：重伤院前救治共识（2026）Chinese expert consensus on prehospital major trauma (2026) · 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)

国内外依据与适用差异Domestic/international scope differences

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.

来源核对日期：2026-10-14；临床审核：进行中Source check: 2026-10-14; clinical review: ongoing

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

危及生命出血：核对药物、末次剂量、INR/肾功能/抗XaLife-threatening bleeding: drug, last dose, INR/renal function/anti-Xa

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.

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。以本院规范为准。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. Follow institutional policy.

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.

创伤失血性休克中国急诊专家共识（2023）Chinese emergency consensus on traumatic hemorrhagic shock (2023) · 围术期出凝血管理麻醉专家共识Chinese anesthesia consensus on perioperative bleeding · 欧洲创伤大出血指南第六版（2023）European major bleeding guideline, sixth edition (2023) · FDA：Andexxa安全通讯（2025-12-18）FDA Andexxa safety communication (2025-12-18) · ACEP：DOAC大出血临床政策（2026）ACEP DOAC major-bleeding policy (2026) · NCS/SCCM：抗栓相关颅内出血更新（2026）NCS/SCCM antithrombotic ICH update (2026) · BSH：andexanet立场声明（2026）BSH andexanet position statement (2026)

国内外依据与适用差异Domestic/international scope differences

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.

来源核对日期：2026-10-14；临床审核：进行中Source check: 2026-10-14; clinical review: ongoing

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

母体优先；子宫左推；Rh DMother first; left uterine displacement; Rh D

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.

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。以本院规范为准。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. Follow institutional policy.

母体不稳定、腹痛/流血或胎心担心：创伤—产科共同升级。Instability, pain/bleeding or fetal concern: trauma/obstetric escalation.

Queensland：妊娠创伤指南Queensland: traumatic injury in pregnancy · 创伤失血性休克中国急诊专家共识（2023）Chinese emergency consensus on traumatic hemorrhagic shock (2023) · BCSH/Qureshi 2014：抗D免疫球蛋白指南BCSH/Qureshi 2014: anti-D immunoglobulin guideline · NHS Highland：妊娠与产后抗D预防路径NHS Highland: anti-D prophylaxis during pregnancy and postnatally

国内外依据与适用差异Domestic/international scope differences

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.

来源核对日期：2026-10-15；临床审核：进行中Source check: 2026-10-15; clinical review: ongoing

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

识别心停即准备；目标 ≤5 min 完成；以本院规范为准。Prepare at arrest recognition; goal delivery by ≤5 min Follow institutional policy.

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.

AHA2025：在心停现场组织产科/麻醉/新生儿团队与复苏性分娩。以本院规范为准。AHA 2025: organize obstetric/anesthetic/neonatal teams and resuscitative delivery at the arrest site. Follow institutional policy.

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。以本院规范为准。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. Follow institutional policy.

AHA 2025：妊娠心脏骤停AHA 2025: cardiac arrest in pregnancy · Queensland：妊娠创伤指南Queensland: traumatic injury in pregnancy

国内外依据与适用差异Domestic/international scope differences

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.

来源核对日期：2026-10-14；临床审核：进行中Source check: 2026-10-14; clinical review: ongoing

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

实测/近期体重；晶体液 10 mL/kg以本院规范为准。Measured/recent weight; crystalloid 10 mL/kg Follow institutional policy.

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.

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。以本院规范为准。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. Follow institutional policy.

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/T 795—2022 儿科输血指南WS/T 795—2022 pediatric transfusion guideline

国内外依据与适用差异Domestic/international scope differences

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.

来源核对日期：2026-10-14；临床审核：进行中Source check: 2026-10-14; clinical review: ongoing

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

RBC : FFP = 1 : 1（容量）以本院规范为准。RBC : FFP = 1 : 1 (volume) Follow institutional policy.

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.

标准举例RBC 20 mL/kg + FFP 20 mL/kg；不是常规贫血或非创伤比例。以本院规范为准。Standard example: RBC 20 mL/kg + FFP 20 mL/kg; not routine anemia/non-trauma ratio. Follow institutional policy.

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。以本院儿科方案为准。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. Follow institutional pediatric policy. Follow institutional policy.

WS/T 795—2022 儿科输血指南WS/T 795—2022 pediatric transfusion guideline · 儿科输血指南重症/大出血编制说明（2025）Chinese pediatric transfusion critical-bleeding interpretation (2025)

国内外依据与适用差异Domestic/international scope differences

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.

来源核对日期：2026-10-14；临床审核：进行中Source check: 2026-10-14; clinical review: ongoing

烧伤：中国新九分法Burns: Chinese rule of nines

成人：9 + 18 + 27 + 46 = 100%以本院规范为准。Adult: 9 + 18 + 27 + 46 = 100% Follow institutional policy.

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.

12岁以下：头面颈=9+(12−年龄)%；双下肢=46−(12−年龄)%。以本院规范为准。Under 12: head/neck=9+(12−age)%; both legs=46−(12−age)%. Follow institutional policy.

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。以本院规范为准。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. Follow institutional policy.

国家卫健委：突发事件烧伤伤员医疗救治规范（2025年版）NHC emergency burn treatment standard (2025 edition; published 2026)

国内外依据与适用差异Domestic/international scope differences

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.

来源核对日期：2026-10-14；临床审核：进行中Source check: 2026-10-14; clinical review: ongoing

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

首24 h：1.5–2 mL × kg × %TBSA + 2000 mL以本院规范为准。First 24 h: 1.5–2 mL × kg × %TBSA + 2000 mL Follow institutional policy.

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.

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。以本院规范为准。Crystalloid:colloid=1–2:1; half estimated total in first eight hours from injury, quarters in next two intervals. Follow institutional policy.

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。以本院规范为准。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. Follow institutional policy.

国家卫健委：突发事件烧伤伤员医疗救治规范（2025年版）NHC emergency burn treatment standard (2025 edition; published 2026)

国内外依据与适用差异Domestic/international scope differences

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.

来源核对日期：2026-10-14；临床审核：进行中Source check: 2026-10-14; clinical review: ongoing

儿童烧伤补液Pediatric burn fluids

首24 h：2 mL×kg×%TBSA（Ⅱ/Ⅲ度）+基础水分；以本院规范为准。First24 hours:2 mL×kg×%TBSA (partial/full thickness)+maintenance Follow institutional policy.

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

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)。以本院烧伤规范为准。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). Follow institutional burn policy. Follow institutional policy.

>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。以本院规范为准。Over5% may cause shock; head/face/neck injury raises airway concern; adjust to previous fluids, circulation and glucose. Follow institutional policy.

国家卫健委：突发事件烧伤伤员医疗救治规范（2025年版）NHC emergency burn treatment standard (2025 edition; published 2026)

国内外依据与适用差异Domestic/international scope differences

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

来源核对日期：2026-10-14；临床审核：进行中Source check: 2026-10-14; clinical review: ongoing

依据与适用范围Sources and scope

课后测 · 5 题Posttest · five questions

每题 1 分；用于形成性反馈。One point per item; formative feedback.

合成情境题Synthetic vignette 1. 81岁男性平地跌倒后髋痛，服用β阻滞剂，HR84次/min、BP104/60 mmHg、SpO₂94%。患肢短缩外旋、皮肤湿冷，家属称既往血压较高，尚无Hb结果，不能只依据低能量机制分流。下一步最合适的是？A 81-year-old man has hip pain after a standing fall and takes a beta blocker; HR 84/min, BP 104/60 mmHg, SpO₂ 94%. The limb is shortened/externally rotated and skin is clammy; baseline BP is higher, Hb is pending and low-energy mechanism may be misleading. What is the most appropriate next step?
合成情境题Synthetic vignette 2. 34岁女性孕28周，车祸后仰卧，HR144次/min、BP78/48 mmHg、SpO₂90%。腹部压痛、子宫高于脐，平卧时头晕加重，无明显外出血；创伤与产科团队正在并行评估。下一步最合适的是？A 34-year-old woman at 28 weeks lies supine after a collision; HR 144/min, BP 78/48 mmHg, SpO₂ 90%. She has abdominal tenderness, uterus above the umbilicus and worse supine dizziness without obvious external bleeding; trauma and obstetric teams are assessing in parallel. What is the most appropriate next step?
3. 儿童出血复苏为何不能照搬成人固定体积？Why should pediatric hemorrhage resuscitation not use a fixed adult volume?
4. 中国新九分法中，一个上肢与双上肢怎样区分？How does the Chinese rule of nines distinguish one versus both upper limbs?
合成情境题Synthetic vignette 5. 33岁女性孕18周，交通伤后腹部压痛，HR102次/min、BP112/70 mmHg、SpO₂96%。母体循环稳定、未致敏RhD阴性，受伤后2 h；本院按英国路径且制剂可用，KB结果尚未回报。下一步最合适的是？A 33-year-old woman at 18 weeks has abdominal tenderness after a collision; HR 102/min, BP 112/70 mmHg, SpO₂ 96%. She is stable, unsensitised and RhD-negative 2 h after injury; the local service uses the BCSH pathway and anti-D is available, with KB results pending. What is the most appropriate next step?