How is total body surface area assessed in burn patients. What are the methods used to calculate TBSA in burn injuries. Why is accurate TBSA assessment crucial in burn management. Which tools and charts are used for burn surface area estimation. How does the Rule of Nines work for burn area calculation. What is the Lund and Browder chart used for in burn assessment. How can digital apps assist in determining burn surface area.

Understanding Total Body Surface Area (TBSA) in Burn Injuries

Total Body Surface Area (TBSA) is a critical metric in assessing and managing burn injuries. It represents the percentage of the body’s surface that has been affected by burns. Accurate TBSA assessment is crucial for determining the severity of the burn, guiding fluid resuscitation, and planning appropriate treatment strategies.

Burn surface area estimation is an essential skill for healthcare professionals dealing with burn patients. Several methods have been developed to calculate TBSA, ranging from simple estimations to more precise charting techniques.

Why is TBSA Assessment Important?

• Guides fluid resuscitation protocols
• Helps determine the need for specialized burn care
• Assists in predicting patient outcomes
• Aids in planning wound management strategies
• Facilitates communication between healthcare providers

The Palm Method: A Quick Estimate for TBSA

One of the simplest methods for estimating burn surface area is the palm method. This technique uses the patient’s palm as a reference point, assuming that the palm (including fingers) represents approximately 1% of the total body surface area.

To use the palm method:

1. Visually compare the size of the burn to the patient’s palm
2. Count how many “palms” would fit over the burned area
3. The number of palms roughly equates to the percentage of TBSA affected

While quick and easy to use, the palm method is best suited for smaller burns or as an initial assessment tool. For more extensive burns, more precise methods are recommended.

The Rule of Nines: A Systematic Approach to TBSA Calculation

The Wallace Rule of Nines is a widely used method for estimating burn surface area in adults. This system divides the body into sections, each representing 9% (or a multiple of 9%) of the total body surface area.

Body Surface Area Distribution According to the Rule of Nines:

• Head and neck: 9%
• Each arm: 9%
• Chest: 18% (9% front, 9% back)
• Abdomen: 18% (9% front, 9% back)
• Each leg: 18% (9% front, 9% back)
• Genitals: 1%

To calculate TBSA using the Rule of Nines, healthcare providers assess each burned area and sum up the percentages. This method is particularly useful for quick assessments in emergency situations.

The Lund and Browder Chart: Gold Standard for TBSA Assessment

The Lund and Browder chart is considered the most accurate method for determining burn surface area, especially in children. This chart takes into account the varying proportions of body parts at different ages, providing a more precise estimation of TBSA.

Key Features of the Lund and Browder Chart:

• Detailed breakdown of body regions
• Age-specific adjustments for body proportions
• Separate calculations for partial and full-thickness burns
• Visual representation of burn areas

Healthcare providers using the Lund and Browder chart shade in the affected areas on a diagram and calculate the corresponding percentages. This method offers the most accurate TBSA assessment, particularly for complex burn patterns.

Digital Solutions: The Mersey Burns App

In the era of digital health, smartphone applications have emerged as valuable tools for burn assessment. The Mersey Burns app is a CE-certified digital solution designed to assist healthcare professionals in calculating burn surface area and fluid requirements.

Advantages of Using the Mersey Burns App:

• Quick and accurate TBSA calculation
• Integration of Lund and Browder chart principles
• Automatic fluid resuscitation calculations
• Easy documentation and sharing of burn assessments
• Regular updates to ensure compliance with current guidelines

The Mersey Burns app combines the precision of traditional charting methods with the convenience of digital technology, streamlining the burn assessment process in clinical settings.

Special Considerations in TBSA Assessment

While the methods described above provide valuable tools for burn surface area estimation, certain factors can complicate TBSA assessment. Healthcare providers must be aware of these considerations to ensure accurate evaluations.

Factors Affecting TBSA Calculation:

• Burn depth variations within a single wound
• Irregular burn patterns
• Presence of unburned areas within larger burn regions
• Body habitus variations (e.g., obesity, amputations)
• Burns crossing multiple body regions

Accurately accounting for these factors requires experience and careful assessment. In complex cases, it may be beneficial to consult with burn specialists or use multiple assessment methods to ensure the most precise TBSA calculation.

Implications of TBSA Assessment on Burn Management

The accuracy of TBSA assessment has far-reaching implications for burn patient management. Understanding these implications is crucial for healthcare providers involved in burn care.

How Does TBSA Assessment Impact Treatment Decisions?

• Fluid Resuscitation: TBSA directly influences fluid replacement protocols, such as the Parkland formula.
• Nutritional Support: Burn size affects caloric and protein requirements for wound healing.
• Wound Care: TBSA guides decisions on topical treatments and dressing selection.
• Surgical Intervention: Extensive burns may require early excision and grafting.
• Transfer Decisions: TBSA is a key factor in determining the need for specialized burn center care.

Accurate TBSA assessment ensures that patients receive appropriate care tailored to the extent of their injuries, optimizing outcomes and reducing complications.

Training and Skill Development in TBSA Assessment

Proficiency in burn surface area estimation requires practice and ongoing education. Healthcare institutions should prioritize training programs to ensure staff competency in TBSA assessment.

Strategies for Improving TBSA Assessment Skills:

• Regular workshops and simulations
• Case-based learning sessions
• Interdisciplinary training involving different healthcare specialties
• Utilization of digital learning platforms and apps
• Periodic competency assessments

By investing in staff education and providing opportunities for skill refinement, healthcare facilities can enhance the accuracy and consistency of TBSA assessments across their burn care teams.

Future Directions in Burn Surface Area Assessment

As medical technology advances, new methods for burn surface area assessment are emerging. These innovations promise to enhance the accuracy and efficiency of TBSA calculations.

Emerging Technologies in Burn Assessment:

• 3D scanning and imaging for precise surface area measurements
• Artificial intelligence algorithms for automated burn analysis
• Telemedicine platforms for remote burn consultations and assessments
• Wearable devices for continuous monitoring of burn wound progression
• Augmented reality tools for interactive burn charting

While these technologies show promise, it’s important to note that they are still in various stages of development and validation. Traditional methods like the Lund and Browder chart remain the gold standard in clinical practice.

As research in this field progresses, healthcare providers can expect more sophisticated tools to complement their clinical judgment in TBSA assessment. The integration of these technologies into burn care protocols may lead to more personalized and precise treatment strategies in the future.

Accurate assessment of Total Body Surface Area in burn injuries remains a cornerstone of effective burn management. From simple estimation techniques to advanced digital solutions, healthcare providers have a range of tools at their disposal to determine TBSA. By understanding the principles behind these methods and staying informed about emerging technologies, clinicians can ensure optimal care for burn patients and contribute to improved outcomes in burn management.

Assessment of burn surface area | Burns (OSH Surgery)

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Whitaker, Iain S. and others (eds), ‘Assessment of burn surface area’, in Iain S. Whitaker, Kayvan Shokrollahi, and William A. Dickson (eds), Burns (OSH Surgery), Oxford Specialist Handbooks in Surgery (

Oxford, 2019; online edn, Oxford Academic, 1 Mar. 2019), https://doi. org/10.1093/med/9780199699537.003.0009, accessed 3 July 2023.

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Abstract

Assessment of total body surface area of a burn injured patient is a crucial step in managing burn injury. The chapter describes a number of techniques from using the size of the patient’s palm as an estimate of 1% to the gold standard Lund and Browder Chart. Key caveats are explained, copies of the charts included as well as the use of the CE certified app Mersey Burns.

Keywords:
burns assessment, TBSA, Lund & Browder, Wallace Rule of Nines, Mersey Burns

Subject

SurgeryDermatology

Series

Oxford Specialist Handbooks in Surgery

Collection:

Oxford Medicine Online

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Appendix VI – Burn and Burn Fluid Charts – CHEMS Field Treatment Guidelines

Table of Contents

A – Adults. B – Children

Percentage of Total Body Surface Area by Age, Anatomic Structure, and Body Habitus

Adult
Anatomic Structure	Surface Area
Anterior head	4. 5%
Posterior head	4.5%
Anterior torso	18%
Posterior torso	18%
Anterior leg, each	9%
Posterior leg, each	9%
Anterior arm, each	4.5%
Posterior arm, each	4.5%
Genitalia, perineum	1%

Child
Anatomic Structure	Surface Area
Anterior head	9%
Posterior head	9%
Anterior torso	18%
Posterior torso	18%
Anterior leg, each	6. 75%
Posterior leg, each	6.75%
Anterior arm, each	4.5%
Posterior arm, each	4.5%
Genitalia/perineum	1%

Parkland Formula
For patients who require fluid resuscitation, consider use of the Parkland formula to calculate the volume of normal saline or lactated Ringer’s solution that should be administered intravenously to ensure hemodynamic stability.

Volume of Intravenous Fluid required in the first 24 hours (in mL) = (4 X patient weight in kg) X (Percentage of total body surface area burned)

The first half of the volume of fluid should be administered over the first 8 hours following the burn with the remaining fluid administered over the following 16 hours.

For pediatric patients, a weight-based assessment tool (length-based tape or other system) should be used to provide a more accurate estimate of the patient’s weight. Likewise, the total body surface area (BSA) estimates are different for pediatric patients compared to adults due to larger head and trunk size. For children, the palmar surface of the hand (not including the fingers is approximately equal to 1% BSA. The guidelines listed above will provide assistance during the estimation of the percentage of total body surface area burned for patients of various ages and body habitus.

Burn Injury IV Fluid Rates
Infusion Rate  Weight > 30 KG

Infusion Rate  Weight < 30 KG

Source: Used with permission, University of Utah Burn Center (https://crisisstandardsofcare.utah.edu).

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Information

• Vacancies
• Details of the institution
• Composition of employees
• Patient’s rights
• Hospital stay rules 50 percent discount.
• Information about the standards of medical care
• List of vital drugs
• List of paid services
• Making an appointment with a doctor
• Processing personal data
• Decree of the Government of the Russian Federation No. 95 dated 20.02.2006 900 14
• Epidemiological Service

Health Development Program

• Territorial program of state guarantees for 2022-2024

Supervisory organizations

• Ministry of Health of the Karachay-Cherkess Republic
• Territorial Compulsory Medical Insurance Fund for the KChR
• Department of Roszdravnadzor
• Insurance company ZAO MAKS-M

For residents of the Karachay-Cherkess Republic added the possibility of another way to independently make an appointment with a doctor through the Telegram messenger . Telegram has implemented the @MedicineOnlineBot chatbot to make an appointment with medical institutions and call a doctor at home.

In the process of making an appointment, users can view a list of specialists of a medical organization, their work schedule. Recording for in-depth medical examination is also available for patients who have undergone COVID-19. Making an appointment and calling a doctor at home are carried out in several steps, user data (call address, contact information) is stored in the database to reduce the amount of information for repeated entries.

at the Consultative and Diagnostic Center of the Republican Children’s Multidisciplinary Hospital (at the address: Cherkessk, Griboyedova St., 81), children will be consulted by specialists (cardiac surgeon, arrhythmologist,) . Moscow.

Pre-registration is carried out by calling the reception:

8(8782) 25-01-27

April 20-21-22, 2023. in the Consultative and Diagnostic Center of the Republican Children’s Multidisciplinary Hospital (at the address: Cherkessk, Griboedov St. , 81), children will be consulted by specialists from the Research Institute named after. G.N. Turner, St. Petersburg.

Specialists of the federal center:

Maxillofacial surgeon: Stepanova Yu.V.

Dear parents!

Children’s polyclinic in Cherkessk

received a vaccine against a new coronavirus infection Gam-Covid-VAK-M for vaccination of children from 12 to 18 years old. Registration for vaccination by phone: 250105. You can also contact the children’s clinic for vaccination. Vaccination is carried out after examining the child with thermometry and the informed written consent of the parent (guardian), or the child himself, who has reached the age of 15 years.

Chief freelance pediatrician of the Ministry of Health of Russia Alexander Baranov: If a child falls ill but goes to school, he will not be able to study normally, and he will infect others

— We are again in a whirlwind of infections, primarily respiratory infections. They strike thousands of our compatriots every day. Children are especially vulnerable,” he said.

❕If a child starts sneezing, coughing, complains of feeling unwell, sore throat, you should not take him to school, it is better to stay at home so as not to infect other children and cope with the disease faster.

Very often parents send their children to school even if they have a temperature, even if it is small, because they are afraid to miss classes – the school program is very busy. If a child gets sick, but goes to school, he himself will not be able to study normally, and he will infect others. in children with respiratory infections, cognitive abilities deteriorate, especially cognitive functions decrease with a cold.

— I would like to appeal to the common sense of moms and dads. But it’s better to skip 2-3 days and treat an incipient cough or a reddened throat than to get seriously ill and, possibly, face complications after the illness, – said the chief freelance pediatrician of the Russian Ministry of Health.

❌ It’s easier to send the child to school;
⭕️ It is wiser to stay at home, help you recover faster and return to learning.

If your family has not yet been vaccinated against influenza and pneumococcal disease, doctors advise getting vaccinated. This will help to avoid many health and learning problems.

Round-the-clock “Hotline” for receiving citizens’ appeals on all issues of medical care by phone: 8 (8782) 20-23-93 department with a department of emergency advisory medical care and medical evacuation (air ambulance): 8 (8782) 20-29-66; 20-35-81

Already today you can get an electronic prescription at the appointment of your doctor in RSBLPU “RDMB”. Install the My Prescription app by downloading it from the App Store, Google Play or the My-prescription.rf website. With the app, you can store all prescriptions, select medicines by active ingredient, information about availability and current prices in pharmacies of the city.

To buy a medicine at a pharmacy, you just need to show the QR code to the pharmacist. You can also add a profile of a relative or child in the My Prescription application through authorization on the Public Services. An electronic prescription is now more than just a prescription!

Licenses

Contacts

For feedback please contact by e-mail
RSBLPU “RDMB”: [email protected]

we ask you to inform the head physician of our institution, Laipanova Tamara Akhmatovna, about this
(with the exact indication of the full name of the doctor and types of studies) by e-mail. mail [email protected]
or by phone

RSBLPU “Republican Children’s Multidisciplinary Hospital” has 3 actual addresses:

Hospital – Cherkessk, st. Griboedova 77a

Polyclinic – Cherkessk, st. Krasnoarmeyskaya 68. – Umar-Aliyeva 12A.

Teenage department – Cherkessk, st. Gagarina 24

do’s and don’ts, types and degrees of burns

Content:

• What is a burn

• Burn degrees

• First aid for burns

• Types of burns and features of first aid

  1. Steamboiling water

  2. Oil painting

  3. Sunbeams

  4. chemicals

  5. electricity

  6. hogweed

  7. iron, hot object

• What not to do when getting burns

• What burns and how can be treated at home

• How to relieve pain from a burn

• In what cases you need to seek medical help

• Burn Treatment Methods

  1. medical devices

  2. Pharmacy means

  3. folk recipes

• How long will it take to live

What is a burn

A burn is an injury to the body resulting from exposure to heat, chemicals, electric current, or radiation. With such an injury, the skin and tissues under it are damaged and destroyed. Injuries occur at home and at work, so it does not hurt everyone to know about the rules for first aid for burns before the arrival of doctors. It is important to quickly navigate and know which remedies can be used for burns, and which are unacceptable. The right actions will slow down the destructive process, which will speed up the healing process.

Burn degrees

The choice of what to do for a burn will depend on the extent of the injury. There are four degrees of severity of burns:

• I degree – superficial damage to the epidermis and dermis;
• II degree – borderline burns, when the skin is deeply affected, but the sebaceous and sweat glands, hair follicles are not damaged;
• III degree – deep lesions with complete skin lesions (necrosis), often with spread to subcutaneous fatty tissue, muscle and bone tissue;
• IV degree – necrosis of the skin, muscles and tendons, down to the bones. Destroyed tissue melts and is gradually torn away over several weeks. The healing process is very long.

The following table shows the correlation of the classification of burn degrees according to ICD-10 with the classification of the XXVII Congress of Surgeons of the USSR in 1960.

The severity of a burn wound is characterized by its depth and area. The first depends on the duration and temperature of the aggressive impact, as well as the timeliness of providing assistance to the victim.

When a person with severe burns is admitted to the hospital, doctors evaluate the damaged area according to the “Rule of nines”, dividing the body into zones, each of which is equal to 9 in percentage terms, respectively:

• head and neck -9%;
• each hand – 9%;
• each leg – 18%;
• front + back torso – 36%;
• and the perineum accounts for the remaining 1%.

First aid for burns

First aid for burns to a person must be provided as soon as possible, already at the scene. First of all, it is important to stop the action of an aggressive agent, if possible, remove clothing and jewelry from the affected area. It is strictly not allowed to remove and pierce blisters, forcibly separate foreign bodies adhering to the skin (splashes of molten metal and plastic, fragments of clothing, etc. ).

During the first 10-15 minutes, cool the damaged skin with running cold water. This will prevent the burn from deepening. In addition, cooling reduces pain and swelling. The victim is given an anesthetic and an antihistamine. Before the arrival of emergency help, he needs to drink non-carbonated mineral water or ordinary, with 1 tsp previously dissolved in it. salt and 0.5 tsp. soda per 1 liter of water.

Types of burns and first aid

Depending on what caused the burn, the steps to provide first aid for burns will differ.

Boiling water steamer

With a small but deep injury, you need to place the burned area under running cold water for 10 minutes and call a doctor. Do not use ointments or other external agents.

Oiled

Usually these are small but deep burns (I-II degrees). Cool the damaged area under a tap with cold water, wait for the doctor to determine the depth and extent of the lesion. There is no need to treat burns of this type.

Sunlight

These are usually 1st degree burns, very rarely 2nd degree burns. Act similarly to the first two points: cool with water for 10 minutes, drink an antihistamine to avoid swelling and painkillers. Do not use ointments and traditional methods of treatment.

Chemicals

Remove the chemical agent from the skin, remove interfering clothing. Rinse under tap for 10 minutes. It is not recommended to wipe with wet wipes, it is forbidden to use ointments and homemade recipes without consulting a doctor. Currently, antidotes are not used to treat such burns.

Electricity

Traces remain at the points of entry and exit of electric current from the body. The burns are small but very deep. First, the current source is de-energized, then immediately turn to a specialist. Damage cannot be repaired.

Hogweed

A plant with caustic sap causes burns of the first or second degree, resembling damage from chemicals. The juice of the plant should be removed from the skin, rinsed under a tap, do not smear the injury site with anything and consult a doctor.

Iron, hot object

Usually these are thermal burns of the II-IV degree. Place the damaged area under running cold water for 10 minutes, apply a dry bandage. It is forbidden to apply ointments, apply ice, use folk remedies.

In each of the above cases, it is recommended as an effective first aid to apply a Branolind dressing to the burn site, and on top of it – a Medicomp non-woven napkin, followed by fixation with a Peha-haft bandage.

Definitely not to do if you get burned

Trying to provide first aid for a burn, out of ignorance, some aggravate the nature of the damage and harm the victim. Doctors strongly advise against doing the following:

• smear the damaged area with fat, as the resulting film will not allow the wound to cool;
• remove clothing stuck to the burn;
• treat the wound with baking soda or vinegar;
• lubricate the burned area with iodine, brilliant green, alcohol-containing compounds;
• apply ice as this will cause vasoconstriction and impair blood flow;
• apply ointments from burns before cooling tissues;
• puncture blisters that form;
• dress the wound with plaster;
• give the victim alcoholic drinks, strong coffee and tea.

What kind of burns and how can be treated at home

Burns of any degree are treated only by a doctor! At home, it is only allowed to provide first aid for first-degree skin burns. We are talking about situations where the area of ​​the wound is not more than 5 percent, while the genitals and head are not affected.

If you list all the procedures briefly, first aid for burns at home consists of the following steps:

1. Cooling the damaged area with water.
2. Branolind dressing.
3. Over the dressing, the imposition of a non-woven cloth Medicomp.
4. Fixation of the lesion site with Peha-Haft bandage.

It should be remembered that only a doctor can determine the severity of the lesion and say exactly how to treat burns at home. If necessary, the victim is hospitalized.

How to relieve the pain of a burn

Since no one is safe from the danger of getting burned, it is necessary to clearly understand what to do with a burn and what first aid to provide. Actions to provide first aid will depend on the causes of the burn.

As a first aid for burns that cause severe pain, you can give him a painkiller tablet to alleviate the suffering of the patient. For minor injuries, accompanied only by reddening of the skin or the formation of small transparent bubbles no larger than 5 cm in diameter, it is recommended to cool the injured area by placing it under running cold water for 10 minutes to prevent damage to deeper tissues. After cooling the affected tissues, the necessary first aid should be provided by treating the burn site with a special agent. It is also advisable to consult a general practitioner to get professional advice on treatment methods that contribute to the rapid healing of the burn.

In more severe cases, medical help should be sought as soon as possible, since delay is fraught with serious complications for the body, up to a threat to the life of the victim.

When to seek medical help

Immediate treatment for first aid for burns is required in the following cases:

• a child or an elderly person has been injured;
• for burns of the face, respiratory tract, inguinal region;
• first-degree burns, if the affected area is large enough – more than 10% of the body;
• with the second degree of damage, if the injured area occupies about 1% of the body surface;
• third and fourth degree burns;
• for burns that have a chemical or electrical cause;
• if it is impossible to relieve pain;
• when the wound is contaminated with earth;
• in any case if the patient has lost consciousness;
• with fever and general malaise.

For the treatment of severe burns of severe degrees, the victim should be placed in the burn unit. It is necessary to stop the pain shock in a short time and prevent the occurrence of complications.

First of all, it must be remembered that even mild burns can be deadly if a large surface area of ​​​​the body is affected.

Burn treatments

Medical devices

Medical care in the treatment of burns is aimed at restoring the affected tissues. In order to relieve pain and speed up the regeneration process, special tools are used. It should be remembered that when providing first aid for a burn, it is important for the victim to thoroughly disinfect their hands first. To do this, you can use the antiseptic for hands “Sterillum”.

After that, the burn site should be covered with a wound-healing antiseptic dressing “Branolind N” with Peruvian balsam. It has a large-celled structure, into which the discharge from the wound is well absorbed, and Peruvian balm will accelerate healing. The bandage can be on the wound for up to three days, which means that the dressings will not cause much concern to the victim. For reliable and careful fixation of the dressing on the wound, a sterile plaster with a soft absorbent vapor-permeable pad “Cosmopor E” is used. It is attached to the body thanks to hypoallergenic glue and reliably protects the injury site from pollution and mechanical stress.

To provide first aid for burns in case of minor injuries, the bandage can also be fixed with a transparent adhesive bandage “Hydrofilm plus”. Its absorbent pad does not stick to the wound. The transparent polyurethane film has water-repellent properties, which means that the bandage will not peel off even during a shower.

To fix the absorbent bandage in the area of ​​the joint or on other rounded parts of the body, a self-locking bandage “Peha-Haft” is used. It does not hinder movement, it is firmly held on the body. Only 1.5-2 turns of the bandage are enough to fix the bandage. The dressing does not stick to the skin and hair, completely hypoallergenic (latex-free). When fixing with a bandage: Branolind N is applied to the wound from above with a sterile absorbent dressing (Medicomp) and then fixed with a Peha-Haft bandage.

Pharmacy products

If the means described above are not at hand, the question arises: how to treat a burn at home? To provide first aid for burns, you can use the tools that are almost always in the home first aid kit: sterile wipes (“Medicomp”), diluted to a concentration of less than 1% with hydrogen peroxide, furacilin, miramistin. A gauze pad can be soaked with hydrogen peroxide solution, which is applied to the wound for a short time. Furacilin has disinfecting properties and can be used to cleanse the wound before applying the anti-burn agent. Be sure to check with your doctor before using any remedy.

Folk recipes

There is an opinion that first-degree burns do not require any treatment, and to treat the affected area, you can use improvised means, for example, treat the skin with oil and sour cream.