观察线索Observation cues
把每一步看成可报告事实。Treat each step as reportable facts.
待审核Pending review
分层创伤课堂Tiered trauma learning
看懂 xABCDE 创伤初评Understanding the xABCDE Primary Survey
本课把 xABCDE 作为组织创伤信息的共同语言：先看明显威胁，再把气道、呼吸、循环、神经、暴露与再评估连成团队心智模型。This course treats xABCDE as shared language for organizing trauma information: visible threats first, then airway, breathing, circulation, disability, exposure, and reassessment as a team mental model.
来源与审核记录Sources and review record待审核Pending review来源可查Source indexed45 minsource_required
xABCDE primary survey map待审核Pending
先发现威胁，再共享事实Notice threats. Share facts.
灾难性外出血Catastrophic external bleedingx气道与颈椎保护Airway & c-spine protectionA呼吸与通气Breathing & ventilationB循环与出血Circulation & haemorrhageC神经功能DisabilityD暴露与环境Exposure & environmentE
预计学习Estimated learning time · 45 分钟min
学完这门课，你能……After this course, you can…
- 用 xABCDE 整合可见威胁与缺失信息。Integrate visible threats and missing information using xABCDE.
- 将新的查体与生理变化转成优先级报告。Turn new examination and physiological findings into a priority report.
- 在每次变化后重新评估患者和团队任务。Reassess the patient and team tasks after each change.
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.
课前测 · 5 题Pretest · five questions
三种学习入口Three Learning Modes
同一门课支持快速复习、系统学习和病例推演。先选模式，再进入对应深度。The same course supports quick review, systematic learning, and case reasoning. Choose the mode before choosing depth.
快速复习模式Quick Review
用一张总览图回忆 x-A-B-C-D-E 与复评循环。Use one overview map to recall x-A-B-C-D-E and reassessment.
来源可查Source indexed 系统学习模式System Learning从 x 和 A 两个完整示范开始，学习“看图思考、判断、复评”。Start with full x and A examples: look, reason, judge, reassess.
待审核Pending review 病例推演模式Case Reasoning逐步释放院前、到院、初评和复评信息，练习信息整合与动态复评。Release prehospital, arrival, primary survey, and reassessment data step by step.
教学示意Teaching schematicxABCDE 总览图xABCDE Overview Map
把六个字母变成观察、报告、团队行动和复评的循环。Turn six letters into a loop of observation, reporting, team action, and reassessment.
立即威胁由团队并行处理；发现变化就重新排序。Teams address immediate threats in parallel; new changes trigger reprioritisation.
看见：描述事实Observe: describe facts01
共享：报告与协助Share: report and assist02
回看：比较变化Return: compare changes03
↺ 检查后、团队干预后、转运后，再回到 xABCDE。↺ Return to xABCDE after tests, team interventions and transfer.
图中为独立合成教学场景，不是同一患者的临床时序。Illustrations are independent synthetic teaching scenes, not a clinical patient timeline.团队行动Team action
按实习、规培与主治层级分配识别、监督下实践和指挥任务。Allocate recognition, supervised practice and leadership by intern, resident and attending level.
待审核Pending review复评问题Reassessment question
资源和检查信息是否改变风险排序。Whether resource and test information changes risk order.
待审核Pending review总论：为什么先学 xABCDEOverview: Why xABCDE Comes First
住院医师和实习医生常有疾病理论，却缺少进入抢救室后组织信息的方法。xABCDE 在本课件中不是处置算法，而是观察顺序、报告语言、团队协作和复评意识。Residents and interns may know disease theory but lack a method for organizing information in the trauma bay. In this courseware, xABCDE is not a treatment algorithm; it is observation order, reporting language, teamwork, and reassessment awareness.
分层实践Tiered practice
实习识别与报告；规培学习决策时机与监督下关键步骤；青年主治组织并行救治、资源与复评。Interns recognize and report; residents learn decision timing and supervised key steps; early attendings coordinate parallel care, resources and reassessment.
反复使用Repeated use
骨盆、颅脑、胸部、腹部和多发伤模块都会回到同一套语言。Pelvis, TBI, chest, abdomen, and polytrauma modules all return to the same language.
团队而非个人Team, not solo
初学者核心任务是识别风险、准确报告、协助准备、知道何时请上级。The learner's core work is recognizing risk, reporting accurately, assisting preparation, and knowing when to escalate.
审核状态Review state
ATLS/ETM 和本地流程相关表述需合法来源核验和医生终审。ATLS/ETM and local workflow statements require legal source verification and clinician signoff.
Reasoning loop
◉描述事实Describe facts
⇄对比变化Compare changes
↺明确复评Plan reassessment
阶段图文卡Stage Cards
x外出血线索：先看环境中的明显威胁External bleeding cues: first read obvious threats in the room
观察床边、衣物与敷料，把位置、范围和变化说清楚。Observe bedspace, clothing and dressings; report location, extent and change.
观察线索Observe
可见污染、敷料变化、床边痕迹。Visible soiling, dressing change, bedspace cues.
团队报告Report
描述位置、变化和不确定点。State location, change, and uncertainty.
复评问题Reassess
新发现是否改变优先级。Whether new findings change priority.
展开解说：这幅图能说明什么？Explain: what can this illustration show?
仅帮助记住观察与沟通任务；不能证明出血严重度、气道是否通畅、通气或灌注是否有效、神经状态或处置安全性。判断要回到动态查体、真实监测和具备资质的团队。It cues observation and communication only. It cannot establish bleeding severity, airway patency, effective ventilation/perfusion, neurological status or procedural safety. Judgement requires serial examination, actual monitoring and a qualified team.
待审核Pending review教学示意Teaching schematic
A气道与脊柱活动限制（SMR）：把声音、体位和团队语言连起来Airway and spinal motion restriction (SMR): connect sound, posture, and team language
观察说话、气道声音与面颈部线索，确认团队保护与协作状态。Observe speech, airway sounds and face/neck cues; confirm team protection and coordination.
观察线索Observe
声音、面颈部、保护状态。Voice, face or neck cues, protection status.
团队报告Report
用中性语言报告风险线索。Report risk cues in neutral language.
资源节点Resource node
上级、气道团队、本地流程。Senior clinician, airway team, local pathway.
展开解说：这幅图能说明什么？Explain: what can this illustration show?
仅帮助记住观察与沟通任务；不能证明出血严重度、气道是否通畅、通气或灌注是否有效、神经状态或处置安全性。判断要回到动态查体、真实监测和具备资质的团队。It cues observation and communication only. It cannot establish bleeding severity, airway patency, effective ventilation/perfusion, neurological status or procedural safety. Judgement requires serial examination, actual monitoring and a qualified team.
待审核Pending review教学示意Teaching schematic
B呼吸与胸廓：把“看起来怎样”变成可报告事实Breathing and chest movement: turn appearance into reportable facts
观察动态胸廓运动、呼吸努力，并结合氧合与通气趋势报告。Observe dynamic chest movement and breathing effort, integrating oxygenation and ventilation trends.
观察线索Observe
胸廓、呼吸努力、肤色趋势。Chest movement, breathing effort, color trend.
团队报告Report
报告表现和趋势，不下结论。Report appearance and trend, not conclusions.
检查节点Information node
床旁影像与团队讨论。Bedside imaging and team discussion.
展开解说：这幅图能说明什么？Explain: what can this illustration show?
仅帮助记住观察与沟通任务；不能证明出血严重度、气道是否通畅、通气或灌注是否有效、神经状态或处置安全性。判断要回到动态查体、真实监测和具备资质的团队。It cues observation and communication only. It cannot establish bleeding severity, airway patency, effective ventilation/perfusion, neurological status or procedural safety. Judgement requires serial examination, actual monitoring and a qualified team.
待审核Pending review教学示意Teaching schematic
C循环与休克线索：把可见和隐匿风险放在同一张图Circulation and shock cues: keep visible and hidden risk on one map
把肤色、脉搏、意识及灌注趋势放回整体风险，继续关注隐匿出血。Integrate skin, pulse, mental status and perfusion trends, remaining alert to occult bleeding.
观察线索Observe
肤色、脉搏趋势、意识变化。Color, pulse trend, mental-status change.
团队报告Report
把担心说成风险地图。Frame concern as a risk map.
资源节点Resource node
血库、影像、介入/手术团队讨论。Blood bank, imaging, IR/surgical team discussion.
展开解说：这幅图能说明什么？Explain: what can this illustration show?
仅帮助记住观察与沟通任务；不能证明出血严重度、气道是否通畅、通气或灌注是否有效、神经状态或处置安全性。判断要回到动态查体、真实监测和具备资质的团队。It cues observation and communication only. It cannot establish bleeding severity, airway patency, effective ventilation/perfusion, neurological status or procedural safety. Judgement requires serial examination, actual monitoring and a qualified team.
待审核Pending review教学示意Teaching schematic
D神经快速概览：报告变化，而不是抢先贴诊断标签Rapid neurologic overview: report change before assigning labels
比较意识、反应和瞳孔的新变化；单一线索不直接等于诊断。Compare changes in consciousness, response and pupils; one cue is not a diagnosis.
观察线索Observe
意识、反应、瞳孔、新变化。Consciousness, response, pupils, new changes.
团队报告Report
报告“变化了什么”。Report what changed.
复评问题Reassess
神经变化是否影响 A/B/C。Whether neurologic change affects A/B/C.
展开解说：这幅图能说明什么？Explain: what can this illustration show?
仅帮助记住观察与沟通任务；不能证明出血严重度、气道是否通畅、通气或灌注是否有效、神经状态或处置安全性。判断要回到动态查体、真实监测和具备资质的团队。It cues observation and communication only. It cannot establish bleeding severity, airway patency, effective ventilation/perfusion, neurological status or procedural safety. Judgement requires serial examination, actual monitoring and a qualified team.
待审核Pending review教学示意Teaching schematic
E暴露与环境：寻找遗漏，同时保护隐私和保暖Exposure and environment: look for missed injuries while protecting privacy and warmth
寻找遗漏损伤，同时确认隐私、保暖与环境；新发现可改变优先级。Look for missed injury while checking privacy, warmth and environment; new findings may change priorities.
观察线索Observe
遗漏伤、环境风险、保暖状态。Missed injury, environment risk, warmth status.
团队报告Report
说明新发现和已查看区域。State new findings and checked areas.
复评问题Reassess
是否需要回到 x/A/B/C/D。Whether to revisit x/A/B/C/D.
展开解说：这幅图能说明什么？Explain: what can this illustration show?
仅帮助记住观察与沟通任务；不能证明出血严重度、气道是否通畅、通气或灌注是否有效、神经状态或处置安全性。判断要回到动态查体、真实监测和具备资质的团队。It cues observation and communication only. It cannot establish bleeding severity, airway patency, effective ventilation/perfusion, neurological status or procedural safety. Judgement requires serial examination, actual monitoring and a qualified team.
待审核Pending review教学示意Teaching schematic
B/C：真实影像只回答有限问题B/C: authentic imaging answers limited questions
框架建立优先级；先描述可见事实，再把它们放回呼吸与循环趋势。The framework establishes priorities. Describe visible findings before linking them to breathing and circulation.
先看哪里Where to look
- 先找患者左侧胸膜线及其外侧缺失的肺纹理，再比较两侧肺野。原图关联的病例叙述为虚构教学情景。Find the left pleural line and absent peripheral lung markings, then compare lung fields. The associated case narrative at the source is fictional teaching material.
这张图不能回答What this image cannot answer
胸片不单独证明张力生理；血流动力学或严重呼吸受损要结合临床。不是本课患者的胸片。The film alone does not establish tension physiology; assess haemodynamics and severe respiratory compromise clinically. It is not the course patient’s film.
原始图注与许可Original caption and licence
User "Clinical Cases" (clinicalcases.org) · CC BY-SA 2.5 · Original source / 原图出处
Left pneumothorax. This X-ray is used on clinicalcases.org to illustrate a fictional case history of tension pneumothorax. Note the large, well-demarcated area devoid of lung markings, the tracheal deviation and movement of the heart away from the affected side. There is also small pleural effusion
Pneumothorax CXR — left pneumothorax used to illustrate tension pneumothorax ·
保留原图；网页仅按比例显示。读图释义由课程另写，不是原作者诊疗结论。Original image retained and displayed proportionally. Teaching interpretation is separate from the original clinical conclusions.
先看哪里Where to look
- 肝与右肾之间的无回声带提示该切面可见游离液体。回答“看到液体了吗”，再问它如何改变风险。An anechoic stripe between liver and right kidney shows fluid in this view. First ask whether fluid is visible, then how it changes risk.
这张图不能回答What this image cannot answer
不能说明液体成分、出血来源、总量或速度。阴性 FAST 不排除腹腔、腹膜后或骨盆损伤。It cannot establish fluid composition, bleeding source, total volume or rate. Negative FAST does not exclude abdominal, retroperitoneal or pelvic injury.
原始图注与许可Original caption and licence
Drahreg01（Wikimedia Commons 用户，本人作品） · CC BY-SA 3.0 · Original source / 原图出处
Ultrasound-image of Morison's Pouch with some fluid
Wikimedia Commons 文件：Ultrasound-image of Morison's Pouch with some fluid（无图号；原文件名 Morison003.jpg） · Wikimedia Commons 文件：Ultrasound-image of Morison's Pouch with some fluid（无图号；原文件名 Morison003.jpg）
保留原图；网页仅按比例显示。读图释义由课程另写，不是原作者诊疗结论。Original image retained and displayed proportionally. Teaching interpretation is separate from the original clinical conclusions.
按威胁重新排序Reprioritise by threat
xABCDE 是共同语言；危及生命的出血与其他立即威胁由团队并行组织，不是做完一项才允许开始下一项。xABCDE provides shared language. Teams coordinate life-threatening bleeding and other immediate threats in parallel, rather than requiring one task to finish before another starts.
不给图像过多权力Do not overinterpret an image
疑似张力生理结合临床严重度；FAST 只提供有限的液体信息，不能单独关闭出血假设。Assess suspected tension physiology using clinical severity; FAST offers limited fluid information and cannot independently close the bleeding hypothesis.
每次更新有责任人Assign an owner to each update
报告变化、未解问题和下一复评时点；检查后、干预后和转运后重新对比。Report changes, unresolved questions and the next reassessment point; compare again after tests, interventions and transport.
暂停判断：阴性 FAST 能否把 C 判定为完成？Pause and decide: Does negative FAST complete C?
不能。继续寻找其他来源，结合灌注变化和下一步诊断或控制出血路径。No. Continue assessing other sources and perfusion changes while planning appropriate diagnostic or haemorrhage-control steps.
核对依据、版本与适用范围Check evidence, version and scope
- ACS ATLS 11 public summary (2025) · xABCDE framework; public summary only
- NICE NG39 (2016; live recommendations) · 1.4 chest; 1.5 haemorrhage and imaging; updates checked at source
- European bleeding guideline, sixth edition (2023) · Recommendations 5,8,11,13,18; physiology, imaging, coagulation, TBI exception, temperature
真实公开图用于观察训练；病例与指南各自标明来源，病例报告不能单独建立普遍治疗规则。Public images support observation training. Case reports and guidelines are distinguished; a case report alone cannot establish a general treatment rule. Clinical applicability remains pending teacher review.
x 完整示范：灾难性外出血Full x Demo: Catastrophic External Bleeding
AI 合成教学场景；请回答观察任务，勿当作真实患者证据。AI-generated training context: answer the observation task, not a patient-evidence question.
这张图只回答一个问题：哪些可见出血线索需要先被团队听见？This image answers one question: which visible bleeding cues must the team hear first?
先看图，再回答Look first, answer next
此时最可能先改变优先级的可见因素是什么？What visible factor may change the first priority?
学习者先说事实：位置、范围、是否变化、哪些仍不确定。不要把观察直接说成治疗指令。Learners first state facts: location, extent, change, and uncertainty. Do not turn observation into a treatment command.
展开答案与临床意义Reveal answer and clinical meaning
- 关键发现：可见出血线索、敷料变化、床边痕迹或肢体外观变化。Key findings: visible bleeding cues, dressing change, bedspace traces, or limb appearance change.
- 临床意义：这些线索可能让团队先回到 x 或 C 重新排序。Clinical meaning: these cues may send the team back to x or C and reorder concern.
- 常见误区：只盯着监护屏，忽略床边可见信息。Common error: staring at the monitor while missing visible bedspace information.
机制解释Mechanism
外部可见线索可提示正在丢失循环容量，但严重程度需由团队结合全局判断。Visible external cues may suggest circulating volume loss, but severity is judged by the team in context.
团队行动Team action
学习者报告，具备资质团队依据指南和本地流程讨论并执行。Learners report; qualified teams discuss and act under guidelines and local policy.
临床判断Judgement
新出血线索是否需要中断当前流程并重新分配角色？Does a new bleeding cue require interrupting the current flow and reallocating roles?
复评Reassess
团队处置后，观察出血、皮肤灌注、意识和趋势是否改变。After team action, observe whether bleeding, perfusion, mental status, and trends changed.
待审核Pending review教学示意Teaching schematic
A 完整示范：气道与颈椎保护Full A Demo: Airway and C-Spine Protection
AI 合成教学场景；请回答观察任务，勿当作真实患者证据。AI-generated training context: answer the observation task, not a patient-evidence question.
这张图只回答一个问题：患者能否维持气道保护，同时团队如何保持颈椎保护语言？This image answers one question: can the patient maintain airway protection while the team preserves c-spine language?
先看图，再回答Look first, answer next
你首先报告“能说话”，还是“需要某种操作”？Do you first report speech and cues, or jump to a procedure?
实习报告气道风险；规培进入九项技能中的气道训练；主治统筹失败救援和人员分工。Interns report airway risk; residents progress to airway skills; attendings coordinate rescue plans and roles.
展开答案与临床意义Reveal answer and clinical meaning
- 关键发现：能否说话、气道声音、面颈部线索、污染风险、颈椎保护状态。Key findings: speech, airway sounds, face or neck cues, contamination concern, c-spine protection status.
- 临床意义：A 的变化可能影响 B/C/D，必须被团队共享。Clinical meaning: change in A can affect B/C/D and must be shared by the team.
- 常见误区：把“看到气道问题”直接变成独立操作，而不是先让团队获得同一事实。Common error: turning an airway concern into solo action instead of first giving the team shared facts.
临床观察重点Observation focus
声音、体位、面颈部线索、污染风险和颈椎保护状态。Voice, posture, face or neck cues, contamination concern, and c-spine protection status.
关键查体Exam focus
只描述可观察发现；具体检查和操作由上级团队主导。Describe observable findings; specific exam and procedures are senior-team led.
危险信号Danger cue
声音或意识变化、污染风险、面颈部变化都应触发报告和复评。Voice or mental-status change, contamination concern, and face/neck changes should trigger reporting and reassessment.
复评Reassess
团队处置后，回看氧合、通气、意识和颈椎保护语言是否仍一致。After team action, revisit oxygenation, ventilation, mental status, and c-spine communication.
待审核Pending review教学示意Teaching schematic
病例推演：高能量交通伤合并休克与胸部损伤Case reasoning: high-energy collision, shock and chest injury
合成教学病例 · 非真实病历。逐条释放是学习节奏，临床立即威胁需要并行处理；选择题不会改写患者生理或评分系统。Synthetic teaching case, not a patient record. Staged release structures learning; immediate threats need parallel care. Choices do not alter physiology or external scoring.
仍未解决Still unresolved
展开团队优先级与下一次复评Team priorities and next reassessment
教师：查看完整病历与全部释放内容Teacher: review full history and all information
主诉Chief complaint
交通碰撞后胸痛、气促与左大腿痛约25分钟（院前预警时）。Chest pain, dyspnoea and left-thigh pain for about 25 min at pre-alert.
现病史History of present illness
32岁男性，系安全带驾驶员，车辆侧向撞击；目击者报告短暂意识不清，持续时间不详。过敏、既往史、药物与末次进食待核实。A 32-year-old restrained driver in a side-impact collision; witnesses report brief unresponsiveness of unknown duration. Allergies, history, medications and last meal need verification.
院前急救措施Prehospital measures
气道观察、吸氧、左大腿伤口加压敷料、临时固定、脊柱保护、保暖、静脉通路和快速转运；未报告胸腔减压或输血。Airway observation, oxygen, thigh pressure dressing, temporary immobilisation, spinal precautions, warmth, IV access and prompt transfer; no reported decompression or transfusion.
初步查体Initial examination
胸痛7/10、短句、湿冷；右胸起伏减弱与呼吸音低，左大腿肿胀伤口、腹部压痛和安全带痕；CRT约4秒。GCS14（E4V4M6），瞳孔等大对光反应存在。Pain 7/10, short phrases and cool clammy skin; reduced right excursion/breath sounds, swollen wounded left thigh, abdominal tenderness and seat-belt mark; CRT about 4 s. GCS 14 (E4V4M6), equal reactive pupils.
到院生命体征Arrival vital signs
HR126次/min；BP88/56 mmHg；RR32次/min；SpO₂92%（面罩6 L/min）；T35.5℃。这是初评时点，不是每读一张卡就新增测量。HR 126/min; BP88/56 mmHg; RR32/min; SpO₂ 92% on face-mask oxygen 6 L/min; T35.5°C. One survey time, not a new measurement with each card.
框架参考公开来源；框架参考公开来源，本课程不是 ATLS 官方课程。Framework uses public sources; this is not an official ATLS course. Clinical teacher review remains pending. ATLS 11 · WSES–AAST 2025 · European bleeding guideline 2023 · Recommendations 9–10
病例矩阵：从框架进入病种Case Matrix: From Framework to Disease Modules
每个病种页均按“机制—动态查体—监护趋势—影像讨论—循证处置—复评”深化，不再只停留在四个通用学习窗口。Each disease page now deepens the shared frame through mechanism, dynamic examination, monitoring trends, imaging discussion, evidence-based management, and reassessment.
C/E：机制、隐匿出血、连续灌注、FAST 边界和资源协作。C/E: mechanism, occult bleeding, serial perfusion, FAST limits, and resource coordination.
指南来源已建立Guidelines mapped进入模块Open module
A/D：连续神经查体、继发性损伤、影像边界和团队升级。A/D: serial neurologic examination, secondary injury, imaging limits, and escalation.
ACS 2024 已核对ACS 2024 checked进入模块Open module
B：受伤机制、反常运动、四阶段呼吸轨迹、影像讨论与处置框架。B: mechanism, paradoxical motion, four-stage respiratory trajectory, imaging, and management.
2025 指南已核对2025 guidance checked进入模块Open module
C/E：连续腹部查体、灌注趋势、FAST/CT 边界和分层处置。C/E: serial abdominal examination, perfusion trends, FAST/CT limits, and stratified management.
WSES 来源已建立WSES sources mapped进入模块Open module
三张同步地图、并行任务、出血/凝血复评和资源冲突。Synchronized maps, parallel tasks, hemorrhage/coagulation reassessment, and resource conflicts.
ATLS/大出血指南已建立ATLS/bleeding sources mapped进入模块Open module
真实经验脱敏后作为教师预览病例，训练 A/D/E 与交接后复评。A de-identified experience used as a teacher-preview case for A/D/E and post-handoff reassessment.
待脱敏审核De-identification pending打开病例Open case
课程作为模拟前思维预热；确定性评分仍由原系统负责。Courseware warms up reasoning before simulation; deterministic scoring remains in the original system.
常见误区Common Pitfalls
把 xABCDE 当成背诵顺序，而不是循环再评估框架。Treating xABCDE as a memorized order rather than a reassessment framework.
应当这样想Use this reasoning持续复评，立即威胁由团队并行处理。Reassess continuously; teams address immediate threats in parallel.
过早固定诊断，忽视新信息和趋势变化。Anchoring early on a diagnosis while missing new information and trends.
应当这样想Use this reasoning同时说出已知事实、未解问题和改变判断的新信息。State known facts, unresolved questions and new information that changes judgement.
把初学者的“行动”误解为独立治疗，而不是报告、协助、准备和让开工作空间。Misreading learner “action” as independent treatment rather than reporting, assisting, preparing, and clearing workspace.
应当这样想Use this reasoning在监督和能力范围内报告、协助、准备，并明确下一次复评。Report, assist and prepare within supervision and competence; identify the next reassessment.
来源与审核状态Sources and Review Status
ACS ATLS 11公开页面作为来源入口，不复制课程内部算法或专有表格。Public page used as a source entry point; no proprietary course algorithms or tables copied.来源可查Source indexed
课程结构资料本地知识库只作为结构输入和待审核线索。Local knowledge base is structure input and review lead only.待审核Pending review
合成病例Synthetic case病例推演不使用真实患者资料，真实病例暂不进入学生公开页。The case simulation does not use real-patient data; real cases stay out of the public student page.教学示意Teaching schematic
xABCDE 教学框架待 ACS ATLS 11 公开页面和合法课程资料核验。The xABCDE teaching frame awaits review against the ACS ATLS 11 public page and legally available course material.
来源可查Source indexedsource_index_pending_review团队并行任务和复评语言待 ETM/本地培训来源审核。Parallel-team-task and reassessment wording awaits ETM/local training source review.
待审核Pending reviewevidence_review_required
临床判断与关键步骤Clinical decisions and key steps
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.
参考数字与立即威胁Reference numbers and immediate threats
B：重伤氧疗B: oxygen for major trauma
储氧面罩15 L/min，成人危重创伤目标SpO₂ 94–98%；血气和高碳酸血症风险指导后续滴定。以本院规范为准。Reservoir mask 15 L/min; target SpO2 94–98% in critically ill adults, then titrate to blood gases/hypercapnia risk. Follow institutional policy.
氧疗后仍低氧并单侧胸部异常、循环受损：立即评估张力性气胸等可逆威胁，不能只加流量后等待。Persistent hypoxia with unilateral chest findings and circulatory compromise requires immediate assessment for reversible threats such as tension pneumothorax.
A：气道与SMRA: airway and SMR
GCS≤8需评估确定性气道；把通气、氧合、出血复苏与脊柱活动限制（SMR）并行组织。以本院规范为准。GCS at or below eight prompts definitive-airway assessment; coordinate ventilation, oxygenation, hemorrhage resuscitation and spinal motion restriction. Follow institutional policy.
不是仅给一个总GCS；记录E/V/M、瞳孔、污染和保护反射，并复查插管后的波形EtCO₂。Record E/V/M, pupils, contamination and protective reflexes, and confirm intubation with waveform capnography.
C：启动、止血、再评估C: activate, control bleeding, reassess
伤后≤3 h尽早TXA：1 g静脉输注至少10 min，后1 g维持8 h；无TBI出血SBP目标80–90，重型TBI MAP≥80 mmHg。以本院规范为准。Give early TXA within three hours: 1 g IV over at least ten minutes, then 1 g over eight hours; bleeding without TBI SBP 80–90, severe TBI MAP at least 80 mmHg. Follow institutional policy.
HR126/SBP88使SI≈1.43；HR与SBP两项已使ABC≥2，应启动大量输血评估并同步寻找止血路径，不能等CT报告。HR 126/SBP 88 gives SI about 1.43; two ABC criteria meet at least two points: activate MTP assessment while arranging hemorrhage control.
创伤失血性休克中国急诊专家共识（2023）Chinese emergency consensus on traumatic hemorrhagic shock (2023) · BTS 成人急救氧疗指南（2017）BTS emergency oxygen guideline (2017) · NICE NG39 重大创伤NICE NG39 major trauma · 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)
新版框架与创伤性心停Updated framework and traumatic arrest
ATLS 11（2025）：公开更新ATLS 11 (2025): public update
ABCDE扩展为xABCDE，更突出危及生命外出血；课程更新覆盖创伤系统、团队沟通与灾难准备。ABCDE expands to xABCDE, highlighting catastrophic external hemorrhage; public updates cover systems, team communication and disaster preparation.
具体手册章节、器械与完整算法以合法课程资料核对；本页仅用公开来源说明变化。Verify exact manual chapters, equipment and full algorithms in authorized course material; this page summarizes public updates.
创伤性心脏骤停Traumatic cardiac arrest
在复苏团队同时纠正出血/低血容量、氧合与气道、张力性气胸、心包填塞；并行处理，避免仅做胸外按压而遗漏病因。The resuscitation team addresses hemorrhage/hypovolemia, oxygenation/airway, tension pneumothorax and tamponade in parallel; do not overlook the cause while performing compressions.
胸廓造口、复苏性开胸等由具备相应技能团队按事件时间、机制、生命征与资源判断。Thoracostomy and resuscitative thoracotomy require skilled teams considering timing, mechanism, signs of life and resources.
ACS：ATLS 第11版公开更新ACS public ATLS 11 update · RCUK 特殊情况复苏指南（2025）RCUK special-circumstances resuscitation (2025)