How to measure burns. Measuring Burns: A Comprehensive Guide to Determining Total Body Surface Area (TBSA)

14.03.198006.12.2021 by alexxlab

How is total body surface area calculated for burn injuries. What are the main methods used to estimate burn surface area. Why is accurate measurement of burn TBSA important for treatment.

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Understanding Total Body Surface Area (TBSA) in Burn Assessment

Determining the percentage of total body surface area (%TBSA) affected by burns is crucial for proper burn injury assessment and treatment. TBSA provides vital information for estimating fluid requirements and determining if transfer to a specialized burn unit is necessary. Several methods exist for calculating TBSA, each with its own advantages and limitations.

Why is TBSA Important?

Accurate TBSA measurement is critical because:

It guides initial fluid resuscitation protocols
It helps determine the severity of the burn injury
It informs decisions about transfer to specialized burn centers
It assists in ongoing burn management and treatment planning

Inaccurate TBSA estimation can lead to inadequate or excessive fluid resuscitation, potentially compromising patient outcomes. Therefore, healthcare providers must be proficient in TBSA calculation methods to ensure optimal burn care.

Common Methods for Estimating Burn Surface Area

Several established techniques are used to estimate the extent of burn injuries:

1. Lund and Browder Chart

The Lund and Browder chart is considered the most accurate method for estimating TBSA, especially for children. It accounts for age-related differences in body proportions.

How does the Lund and Browder chart work? This method uses a detailed diagram of the human body, divided into sections with assigned percentage values. The clinician shades in the burned areas on the chart and adds up the percentages to calculate the total TBSA affected.

2. Wallace’s Rule of Nines

The Rule of Nines is a quick and convenient method for estimating TBSA in adults, particularly useful in emergency situations.

How is the Rule of Nines applied? This technique divides the adult body into 11 areas, each representing roughly 9% of the total body surface (hence the name). The areas are:

Head and neck: 9%
Each arm: 9% (18% total for both arms)
Chest: 9%
Abdomen: 9%
Upper back: 9%
Lower back: 9%
Each leg: 18% (36% total for both legs)
Genitals: 1%

While quick and easy to use, the Rule of Nines is less accurate for children and obese individuals due to different body proportions.

3. Palmar Method

The Palmar method, also known as the Rule of Palm, is useful for estimating smaller burns.

How is the Palmar method used? This technique assumes that the patient’s palm (including fingers) represents approximately 1% of their total body surface area. By comparing the burn size to the patient’s palm, clinicians can estimate the TBSA affected.

It’s important to note that the patient’s hand should be used for this measurement, not the clinician’s, to account for individual variations in hand size relative to body size.

Factors Affecting TBSA Calculation Accuracy

Several factors can influence the accuracy of TBSA estimation:

Age: Children have different body proportions compared to adults, requiring age-specific charts or adjustments
Body habitus: Obesity can alter body proportions, affecting the accuracy of methods like the Rule of Nines
Burn patterns: Irregularly shaped or scattered burns can be more challenging to measure accurately
Clinician experience: Proper training and experience in burn assessment can improve accuracy
Time constraints: Emergency situations may necessitate quicker, less precise methods

Healthcare providers should be aware of these factors and choose the most appropriate method based on the specific situation and patient characteristics.

Tips for Accurate TBSA Measurement

To enhance the accuracy of burn surface area estimation, consider the following tips:

Use the Lund and Browder chart for the most precise measurements, especially in children
Employ the Rule of Nines for quick assessments in adults during emergency situations
Utilize the Palmar method for smaller burns or to supplement other techniques
For severe burns (>50% TBSA), consider calculating unburned areas and subtracting from 100% for easier estimation
Always use the patient’s hand, not the clinician’s, when applying the Palmar method
Regularly reassess burn extent, as appearances can change over time
Collaborate with colleagues to cross-check estimations, especially in complex cases

The Role of TBSA in Burn Management

Understanding the importance of TBSA in burn management is crucial for healthcare providers. TBSA impacts various aspects of patient care, including:

Fluid Resuscitation

How does TBSA affect fluid resuscitation? The estimated TBSA is a key factor in calculating fluid requirements for burn patients. The widely used Parkland formula takes into account both TBSA and the patient’s weight to determine initial fluid resuscitation volumes.

For example, the Parkland formula suggests administering 4 mL of Ringer’s lactate per kilogram of body weight per percent TBSA burned over the first 24 hours post-injury. Half of this volume is given in the first 8 hours, with the remainder administered over the next 16 hours.

Transfer Decisions

TBSA estimation plays a crucial role in determining whether a patient requires transfer to a specialized burn center. Generally, adults with burns covering more than 20% TBSA and children with burns exceeding 10% TBSA are candidates for transfer to a burn unit.

Ongoing Care Planning

Accurate TBSA measurement helps guide ongoing treatment decisions, including:

Nutritional support requirements
Wound care strategies
Rehabilitation planning
Psychological support needs

Challenges in TBSA Estimation

Despite the importance of accurate TBSA measurement, several challenges can affect its precision:

Interobserver Variability

Different healthcare providers may estimate TBSA differently, even when using the same method. This variability can lead to inconsistencies in patient care.

How can interobserver variability be minimized? Regular training, standardized assessment protocols, and the use of digital tools can help reduce discrepancies between observers.

Depth Assessment

While TBSA focuses on the extent of burns, accurately assessing burn depth is equally important for treatment planning. However, burn depth can be challenging to determine, especially in the early stages of injury.

Why is burn depth assessment challenging? Burn wounds can evolve over time, and initial appearances may not accurately reflect the final depth of the injury. Technologies like laser Doppler imaging can aid in more precise depth assessment, but they are not always readily available in all clinical settings.

Special Populations

Certain patient groups present unique challenges in TBSA estimation:

Infants and young children: Rapidly changing body proportions require age-specific charts and frequent reassessment
Obese patients: Altered body proportions can affect the accuracy of standard measurement techniques
Elderly patients: Thin, fragile skin may complicate burn assessment

Emerging Technologies in Burn Assessment

As medical technology advances, new tools are being developed to enhance the accuracy and consistency of burn assessment, including TBSA calculation:

3D Scanning and Imaging

Three-dimensional scanning technologies offer the potential for more precise TBSA measurements. These systems can create detailed 3D models of a patient’s body, allowing for accurate surface area calculations.

How do 3D scanning systems work for burn assessment? Specialized cameras capture multiple images of the patient from various angles, which are then processed by software to create a 3D model. Burn areas can be mapped onto this model, providing a highly accurate TBSA measurement.

Artificial Intelligence and Machine Learning

AI-powered image analysis tools are being developed to assist in burn assessment. These systems can analyze photographs or scans of burn injuries to estimate TBSA and potentially assess burn depth.

What are the advantages of AI in burn assessment? AI systems have the potential to reduce interobserver variability, provide rapid assessments, and potentially identify subtle features that might be missed by human observers.

Mobile Applications

Several smartphone apps have been developed to aid in TBSA calculation. These apps often incorporate digital versions of traditional assessment methods, such as the Rule of Nines or Lund and Browder charts.

How can mobile apps improve TBSA estimation? By providing standardized tools and built-in calculators, these apps can help reduce errors and improve consistency in burn assessment, especially in settings where specialized burn expertise may be limited.

The Future of Burn Assessment and TBSA Calculation

As research in burn care continues to advance, we can expect further improvements in TBSA estimation techniques and overall burn assessment. Some areas of ongoing development include:

Biomarkers for Burn Severity

Researchers are investigating various biomarkers that could provide objective measures of burn severity, complementing visual TBSA estimation.

How might biomarkers enhance burn assessment? Certain proteins or metabolites in the blood or urine could potentially indicate the extent of tissue damage, offering an additional tool for assessing burn severity and predicting outcomes.

Telemedicine in Burn Care

The growth of telemedicine presents both opportunities and challenges for burn assessment. Remote evaluation of burns, including TBSA estimation, is becoming increasingly important, especially in rural or underserved areas.

What are the implications of telemedicine for TBSA estimation? While telemedicine can improve access to burn expertise, it also requires the development of standardized protocols for remote assessment and the use of technologies that can accurately convey burn characteristics through digital means.

Personalized Burn Care

As our understanding of individual variations in burn response grows, there is a trend towards more personalized approaches to burn care.

How might personalized medicine affect TBSA assessment? Future burn assessment tools may incorporate factors such as genetic predisposition, comorbidities, and individual healing capacity to provide more tailored treatment plans beyond simple TBSA calculations.

In conclusion, accurate measurement of total body surface area affected by burns remains a critical component of burn care. While traditional methods like the Lund and Browder chart, Rule of Nines, and Palmar method continue to be widely used, emerging technologies and ongoing research promise to enhance the precision and consistency of TBSA estimation. As burn care evolves, healthcare providers must stay informed about the latest developments in burn assessment techniques to ensure optimal patient outcomes.

Burn %TBSA – Vic Burns

A burn injury to the entire back is 18% TBSA in an adult
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The extent of injury is best described using the percentage of the total body surface area (%TBSA) that is affected by a burn. The measurement of burn surface area is important during the initial management of people with burns for estimating fluid requirements and determining need for transfer to a burns service.

There are several methods that provide a reproducible estimation of the area of surface area burns.

The methods for estimating TBSA are:

Several studies have compared the various methods of estimating burn surface. The Lund Browder charts are more accurate than either the Rule of Nines or palm size in identifying TBSA. The Rule of Nines is faster and more convenient to use for adult burn patients in emergency situations, however, it is not accurate for children or for obese people.

Bilateral circumferential leg burns is a 36%TBSA burn in an adult
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Tips:

With severe burn injuries (>50%TBSA) it maybe easier to calculate what isn’t burnt then subtract it from 100 to get %TBSA burns
Use the Palmar method to calculate %TBSA for smaller burns. Palmar method uses the size of the patients hand (palm and fingers) to estimate burn size. Remember to always use the patients hand, not the clinicians.
In the prehospital and emergency department setting, the %TBSA burns is more important than the depth of burn. %TBSA burns has indications for severity of injury, fluid resuscitation and transfer destination. Depth of burn becomes more significant after arrival at the Burn Service as depth of burn will determine whether the burn can heal without surgical intervention, and how the Burn Service will subsequently manage it.
If %TBSA burn estimation is inaccurate it has the potential to negatively impact fluid resuscitation by providing too much or too little fluid. Always titrate fluid resuscitation volumes according to resuscitation end points. Urine output is a simple and easy method to assess perfusion

A burn involving half the chest & 3/4 of the arm is at approx 16%TBSA
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Introduction | Mersey Burns for calculating fluid resuscitation volume when managing burns | Advice

Introduction

Burn injuries can result from exposure to heat (including flames, hot liquids or objects; referred to as thermal burns), chemicals, electricity or radiation. The International Burn Injury Database recorded that 81,181 patients attended specialist burn services for assessment and admission in England and Wales between 2003 and 2011 (Stylianou et al. 2014).

Appropriate burn injury assessment and management is critical to ensure the best outcomes for patients. The severity of a burn injury is assessed by its depth, extent and location, the patient’s age and the presence of other injuries or diseases. The extent of a burn is expressed as the percentage of the body surface area affected. This is referred to as the total burn surface area (TBSA). There are several standard methods for estimating TBSA: the Lund and Browder chart; Wallace’s Rule of Nines; and the Rule of Palm (Hettiaratchy and Papini, 2004).

The Lund and Browder method is a paper chart with an outline of a person divided into several regions, each represented by a number. The chart is shaded to show the burned area and the TBSA is calculated by adding the numbers for each affected region. In babies and children, the head and legs make up different proportions of the body surface area, so the chart includes age‑related numbers for these areas (Hettiaratchy and Papini, 2004). Wallace’s Rule of Nines estimates the affected body surface area of an adult using multiples of 9 representing different areas of the body. Different calculations are used for children and infants. The Rule of Palm assumes that the palm (including the fingers) of the person who is burned is about 1% of the body. This can be used to calculate the body surface area burned. However, all of these methods are reported to provide inaccurate estimates of TBSA (Giretzlehner et al. 2013; Parvizi et al. 2014).

One of the major complications associated with severe burns is fluid loss, so replacing lost fluids (fluid resuscitation) is important. The amount of resuscitation fluid needed in the first 24 hours after the burn injury is based on the TBSA and the person’s body weight. There are several formulae to calculate fluid requirements; the most commonly used one in the UK is the Parkland formula, devised at the Parkland Memorial Hospital in the USA (Baker et al. 2007). Half of the fluid needed is infused intravenously over the first 8 hours after the burn injury, and the second half is given over the next 16 hours. Children may need additional intravenous background (maintenance) fluids, which also need to be calculated.

Because several calculations are needed to devise a fluid resuscitation protocol, there is potential for error. Inaccuracies in TBSA estimates can have a profound impact on fluid resuscitation outcome, morbidity and mortality (Parvizi et al. 2014). As appropriate fluid resuscitation is essential, physiological parameters are also monitored to assess the patient’s response and to help avoid complications. Giving too much fluid can give rise to cardiac failure, an increased risk of infectious complications, acute respiratory distress syndrome, abdominal compartment syndrome, and even death. Giving too little fluid can lead to hypovolaemic shock, organ failure and systemic inflammatory response syndrome (Luo et al. 2015).

Burns Percentage Surface Area

Following first aid measures, it is important to be able to assess the burn and determine the percentage surface area that is affected. This percentage or area determines what fluid resuscitation is needed in hospital, and whether the child needs to be admitted. It is important to be as accurate as possible, and the following systems are used for assessment in adults and children.
The most important part to remember is NOT to include the areas of burnt skin which is just red and erythematous, as this area does not affect the structure of the skin, as it isn’t broken, and therefore should not be included in the estimation.
There are many helpful tools for estimation of surface area. We have included a really useful image for this purpose, downloadable at the bottom of this page in pdf form.

Other methods of assessing percentage burns include the following:

Lund and Browder Chart
This takes into account the percentage area of each segment of the body, and allows easy estimation of affected area by drawing on the affected area. Children have different body segment percentages, which change with age due to having relatively large heads, and short limbs initially.
Mersey Burns App
This app on your phone, allows you to colour in the areas affected and calculates a percentage for you. It helpfully corrects for age and size if you put the data in.

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learning?

This content is taken from
University of Birmingham online course,

Emergency and Urgent Care for Children: a Survival Guide

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General Rule
As a rough measure, the child’s palm and finger surface area of one hand (not the examiner’s) represents 1% TBSA – and this applies to everyone, adults and children. Hence it’s the patient’s palm that is used for estimation.

Assessment of Depth of Burn

Burns depth assessment may be difficult, especially in the acute phase when the skin is red and the child is very upset.
The table below aids accurate estimation of burn depth, which is important for further management in hospital.

Depth	Cause	Surface/Colour	Pain Sensation
Superficial	Sun, flash, minor scald	Dry, minor blisters, erythema, brisk capillary return	Painful
Superficial Partial thickness -(superficial dermal)	Scald	Moist, reddened with broken blisters, brisk capillary return	Painful
Deep Partial thickness – (deep dermal)	Scald, minor flame contact	Moist white slough, red mottled, sluggish capillary return	Painless
Full thickness	Flame, severe scald or flame contact	Dry, charred whitish. Absent capillary return	Painless

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This content is taken from University of Birmingham online course

Emergency and Urgent Care for Children: a Survival Guide

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Parkland Formula Article

Continuing Education Activity

Early and aggressive fluid resuscitation plays a fundamental role in the management of severe burn patients. The Parkland formula is the most widely used resuscitation protocol that aids in calculating initial fluid requirements for these patients. This activity describes the Parkland formula and its purpose, indications, complications, and modifications, while highlighting the role of the interprofessional team in managing fluid resuscitation in victims of critical burn injuries.

Objectives:

Explain the pathophysiology of burn injury as it relates to fluid status in a critical burn patient.

Describe the Parkland formula and its indications, as well as how to monitor adequate fluid resuscitation in the severe burn patient.

Identify potential modifications of the Parkland formula and complications of both under and over-resuscitation of fluid in the critical burn patient.

Summarize the importance of collaboration and communication amongst the interprofessional team enhance care coordination to improve outcomes in patients with critical burn injuries

Introduction

While major burns can cause considerable local damage and tissue injury, they can also result in a widespread inflammatory response that may affect the entire body. With this in mind, the severe burn patient should always be handled systemically, with primary attention to the patient’s ABC’s (airway, breathing, and circulation). To learn more about the initial approach to severe burn injuries, take a look at the “Burns, Evaluation and Management” section. This section will focus specifically on fluid resuscitation in the critical burn patient. Once airway and breathing have been addressed, the next step in the algorithm is to assess circulation. Early and aggressive fluid resuscitation plays a fundamental role in the management of circulation in severe burn patients.

Anatomy and Physiology

Severe burn injuries trigger activation of the complement system and release of inflammatory and vasoactive mediators. These mediators increase local and systemic capillary permeability, leading to the rapid displacement of intravascular fluids, electrolytes, and plasma proteins into the interstitial space. This extensive capillary leak results in large fluid shifts, intravascular fluid depletion, and significant edema of both burned and non-burned tissue. This response can begin within minutes and rapidly transpires over the first 24 hours after the injury occurs. Maximum intravascular hypovolemia and edema formation peaks at about 8–12 hours post-injury. Massive systemic fluid loss, accompanied by decreased cardiac output and increased vascular resistance, eventually lead to critical hypoperfusion and subsequent tissue injury. This phenomenon, known as “burn shock,” is a combination of distributive, hypovolemic and cardiogenic shock, and is treated with aggressive fluid resuscitation. The aim of fluid management in severe burn injuries is to maintain tissue perfusion and prevent end-organ ischemia in the earliest phases of burn shock. Prompt and adequate fluid resuscitation has consistently shown to decrease morbidity and mortality in victims of severe burns. This improvement in outcomes has led to the development of many resuscitation protocols that aid in calculating initial fluid requirements. The Parkland formula, originated by Baxter and Shires in 1968, remains the most well-known and widely used regimen to date[1][2]

Indications

The Parkland formula is used to calculate fluid resuscitation for critical burn patients. This formula is used specifically for patients who have sustained large deep partial thickness or full-thickness burns of greater than 20% of their total body surface area in adults, and greater than 10% total body surface area in children and the elderly. It is also useful for patients with smaller burns who sustained oral or inhalation injuries and are unable to tolerate fluids by mouth.

Contraindications

No absolute contraindications exist to use of the Parkland fluid. Initiation of fluid resuscitation is an option in patients with comorbidities such as heart failure and end-stage renal disease, with close monitoring of volume status. Oral hydration should be used in patients with smaller burns that can tolerate PO.

Preparation

Like with any trauma or critical patient, two large-bore peripheral IVs should be placed immediately, preferably through unburned skin, although IVs placed through burned skin are acceptable. Peripheral intravenous access is the most efficient and least invasive way to administer high volumes of fluid. Peripheral IVs can be sutured in place to avoid losing access. If peripheral access is unattainable, central venous catheterization or an interosseous line must be a considered approach. It is important to remember that severe burn patients are often involved in trauma. Hypotension is often a late finding in burn shock. If a patient arrives hypotensive, always consider other traumatic causes of low blood pressure, such as hemothorax, cardiac tamponade, neurogenic shock, and internal abdominal and pelvic bleeding.

Technique

The first step in addressing the fluid needs for a burn patient is to determine the extent of the injury, which is by calculating the percentage of body surface area (%BSA) injured. Of note, only those areas suffering from deep partial-thickness burns (previously known as 2nd-degree burns) or a full-thickness burn (formerly known as 3rd & 4th-degree burns) are included in the calculation. Superficial partial thickness (1st-degree burns) should not qualify for inclusion. The “Wallace Rule of Nines” is the most common method of determining BSA. In the adult formulation, the head is 9%, each circumferential upper extremity is 9%, each circumferential lower extremity is 18%, the anterior trunk is 18%, the posterior trunk is 18%, and the perineum is 1%. This formulation is modified for the pediatric population due to the larger head size relative to the body. In the pediatric formulation, the head increases to 18% and lower extremities each decrease to 14%. For a more accurate calculation of %BSA, particularly with children, the “Lund and Browder Chart” can be utilized. This chart expands on the %BSA of the head and lower extremities by considering variations in age. For a quick approach to calculating %BSA, one can use the “Rule of Palm.” This rule states that the patient’s palm, not including fingers or wrist, approximates 1% of their own BSA. Thus, a quick estimate of a patient’s %BSA is obtainable by measuring the number of the patient’s own palms it would take to cover their burn injury. The key here is to use the palm of the patient and not the palm of the provider.

The Parkland formula estimates the fluid requirements for critical burn patients in the first 24 hours after injury using the patient’s body weight and the percent of total body surface area that is affected by thermal burns. The formula recommends 4 milliliters per kilogram of body weight in adults (3 milliliters per kilogram in children) per percentage burn of total body surface area (%TBSA) of crystalloid solution over the first 24 hours of care.

Parkland Formula

4 mL/kg/%TBSA (3 mL/kg/%TBSA in children) = total amount of crystalloid fluid during first 24 hours.

Delivery of half the volume is in the first 8 hours post-burn, and the remaining volume given over the next 16 hours. Children should receive maintenance fluid in addition to their calculated fluid requirements. Of note, the first eight hours of resuscitation is from the time of burn injury, not from the time of evaluation. Thus, the first half of total fluid amount may need to be administered at a faster rate if the patient has a delayed time before evaluation. Lactated Ringers is the preferred choice of crystalloid solution, as it effectively treats both hypovolemia and extracellular sodium deficits caused by burn injury, and it is isotonic, inexpensive, readily available, and easily stored. Also, large volumes of normal saline solution can lead to hyperchloremic acidosis.[3][4][5][6]

Complications

Keep in mind that these formulas are meant to serve only as a guide for fluid resuscitation. Several studies have shown that the Parkland formula may underestimate fluid requirements for certain critical burn patients. Patients with inhalation injuries, electrical burns, full-thickness burns, and those in who experience delayed resuscitation are among the specific patient populations that frequently need more fluid than what is calculated by the Parkland formula. Under resuscitation with fluids can lead to unstable vital signs, acute renal failure, and further end-organ injury. Acute renal failure in burn settings may necessitate temporary dialysis. There is also emerging evidence that some severely burned patients with major burns receive far more fluid than is recommended by the Parkland formula. Over-resuscitation has been shown to increase complications such as abdominal and extremity compartment syndromes, cerebral edema, acute respiratory distress syndrome, a higher risk of sepsis, and multi-organ dysfunction. The term for this phenomenon is “fluid creep.”[7]

Clinical Significance

Managing fluids in burn and trauma patients are challenging. Several studies have concluded patients who receive larger volumes of resuscitation fluid may be at higher risk for complications and death. As such, the rates of the fluid administration in major burns are a focus of controversy. The Parkland formula offers a rational approach for adequate fluid resuscitation, however, the use of the formula must also include good clinical judgment.

Enhancing Healthcare Team Outcomes

The best single indicator of adequate fluid resuscitation in major burn patients is hourly urine output. Once IV access is established, and fluids initiated, placement of a Foley catheter should take place in order to monitor urine output. The fluid rate should be adjusted to maintain urine output between 0.5 and 1 mL/kg/hour in adults, and between 1.0 and 1.5 mL/kg/hour in children. Organ perfusion should also be evaluated by the patient’s heart rate, blood pressure via arterial monitoring, capillary refill time, and mental status. Patients who have an acceptable volume status and urine output, but remain hypotensive may require vasopressors or inotropic agents to improve cardiac output and maintain systemic perfusion pressures [Level 1].

Though sufficient fluid resuscitation is essential during the initial 24 hours after injury, burn patients must remain adequately hydrated throughout their entire recovery process. After 24 hours, fluid should be switched from Lactated Ringers to 5% dextrose in half normal saline (D5½NS), and given at a maintenance rate. Recent practice guidelines for burn shock resuscitation consider supplementation of colloid-containing fluid after the first 24 hours post-burn, as it has shown to decrease overall fluid requirements. During the second 24-hour period, stop crystalloids and initiate colloids at 20-60% of calculated plasma volume and dextrose in water. A modified Parkland Formula provides more specific recommendations for the second 24 hours, advising colloid infusion of 5% albumin at the amount of 0.3-1.0/16 mL/kg/%BSA/hr [Level 1].[6][3]

(Click Image to Enlarge)

Wallace Rule of Nines for determining percent of burned body surface area.

Contributed by OpenStax College, (Public Domain)

Calculating body surface area: Burn assessment for EMS

I attended several great sessions at the recent EMS Today conference in Tampa. One of the best was “The fire’s out, now what? Emergent burn care lessons” by Debbie Harrell, RN, MSN, NE-BC from the Shriner’s Hospitals for Children–Cincinnati.

Inhalation injury quick assessment

During her session, Harrell covered many points of burn care, but her description of a quick assessment for inhalation injury really stood out. Likening it to “putting the puzzle pieces together,” Ms. Harrell showed how four elements can provide BLS and ALS providers a quick way to triage the patient as low, moderate and high risk for inhalation injury. As with all good triage tools, it requires no equipment, no counting and no numbers or formulas to memorize.

Four elements can provide BLS and ALS providers a quick way to triage the patient as low, moderate and high risk for inhalation injury.

Mental status. The puzzle starts with an assessment of the patient’s mental status. Burns do not affect the level of consciousness unless the airway or respiratory system are directly involved. If the patient’s level is anything other than awake and oriented, they should immediately be considered high risk. An altered level of consciousness in a burn patient is likely due to:
- Hypoxia from airway compromise,
- Carbon monoxide or other toxic gas poisoning or
- Traumatic injuries
Physical assessment. Next, conduct a quick physical assessment and note any visible burns to the face or singing of the nasal hair. Many of us learned that these are critical findings worthy of immediate airway intervention, but Harrell said that this is not usually the case. Unless there are other positive signs, these patients may be low risk. She stressed that the human body usually does a good job of protecting the airway from burns.
Location of the fire. A commonly overlooked piece of the puzzle is the location of the fire. Was the patient exposed to the fire, heat and smoke inside a building or other confined space, or were they outside where there is less chance that the heat was concentrated? Being inside a building when a fire breaks out, or worse yet, an explosion occurs, brings a much higher risk of upper and lower airway inhalation injuries.
Respiratory status. Last but not least, do a quick assessment of the patient’s respiratory status. This can begin with asking the patient what happened. Is their voice hoarse or do you hear any stridor as they breathe? Are they exhibiting any signs of respiratory distress other than the increased respiratory rate that may be simply due to the scary situation they just experienced? Look inside their mouth for any signs of carbonaceous sputum. Their answer to your “what happened” question should also confirm their level of consciousness.

If the patient shows an abnormal finding in any one of the last three puzzle pieces (physical assessment, location of the fire or respiratory status), then they have a low risk for an inhalation injury. Continue with a standard primary and secondary assessment to determine other injuries.

Two or more findings in the last three puzzle pieces puts the patient at moderate risk. Monitor the patient closely for changes and continue your assessment.

Top takeaways on burn assessment

Of course, burns present more hazards then just inhalation injuries and Harrell went on to touch on some important points of treating all burn injuries. Here are three takeaways from her presentation.

1. Hypothermia is a risk in burn treatment

Hypothermia is a significant complication in burn patients. Only cool the burn area enough to put out the fire. Use room temperature water for no more than 2-3 minutes and never use ice; it can actually worsen the injury.

2. Evaluate body surface area for 20%

Don’t spend too much time and effort on calculating the amount of body surface area (BSA) burned. It is more complicated than it looks and often, the severity of the burn evolves over time. It is more important to keep the patient covered and warm. Just estimate if the BSA is less than or greater than 20%.

3. Fluid administration rates for burn treatment

IV fluids are critical only if the BSA is greater than 20%. Patients younger than 2 or older than 65 are exceptions and should get IV fluids even for smaller burns. If IV fluids are administered, lactated Ringer’s is preferred but normal saline is acceptable, especially in the early stages. Administer the fluids at:

125 mL/hr for children 5 years and younger
250 mL/hr for kids 6-14
500 mL/hr for patients older than 14

Additional resources on burn assessment, treatment

Certainly, pre-hospital and hospital-based burn care involves much more. Harrell encouraged all providers to seek out more burn care training including the basic and advanced burn life support courses. You can also contact her at the Shriners Hospitals for Children–Cincinnati to bring her or one of their educators to your area for a class.

Learn more about burn assessment and treatment with these resources:

Stay safe out there.

burn | injury | Britannica

burn, damage caused to the body by contact with flames, hot substances, certain chemicals, radiation (sunlight, X rays, or ionizing radiation from radioactive materials), or electricity. The chief effects of contact with flame, hot water, steam, caustic chemicals, or electricity are apparent promptly. There is a delay of several hours before the full effects of sun or ultraviolet burns are apparent and a delay of 10 to 30 days before the full effects of ionizing radiation burns are apparent.

The severity of a burn depends largely on the depth of tissue destruction and the amount of body surface affected. Other factors—including the patient’s age and prior state of health, the location of the burn wound, and the seriousness of any associated injuries—can also influence recovery from a burn.

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For an appreciation of how depth and size of a burn affect the severity of the injury, some understanding of the anatomy and physiology of the skin is necessary. Human skin is composed of two layers: an upper layer called the epidermis, and a lower layer known as the dermis (or corium). The largest of the body’s organs, skin performs a number of vital functions. Its foremost job is to separate the external environment from the body’s interior. The epidermis, the outer surface of which consists of dead, cornified cells, prevents infectious microorganisms and other harmful environmental agents from gaining entrance to the body. The dermis, by contrast, is made up of fibrous connective tissues that prevent the evaporation of body fluids. Embedded within the dermis and opening to the skin surface are the sweat glands. These secrete perspiration, the evaporation of which helps regulate body temperature. Perspiration also contains small amounts of sodium chloride, cholesterol, aluminum, and urea; it thus plays a role in regulating the composition of body fluids. The dermis also contains all of the skin’s blood vessels and nerves, including sensory nerve endings that respond to touch, pressure, heat, cold, and pain. The skin therefore also serves as a sense organ that enables a person to adjust to changing environmental conditions. One final function of the skin is the synthesis of vitamin D, a compound essential to growth and maintenance, particularly of bone. Vitamin D is formed by the action of sunlight on certain cholesterol compounds in the dermis. Destruction of the skin by deep or extensive burns can disrupt all of these functions, subjecting the victim to serious complications.

Physicians have traditionally categorized burns as first-, second-, or third-degree injuries, according to the depth of skin damage (see illustration). In a first-degree burn, only the epidermis is affected. These injuries are characterized by redness and pain; there are no blisters, and edema (swelling due to the accumulation of fluids) in the wounded tissue is minimal. A classic example of a first-degree burn is moderate sunburn.

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The damage in a second-degree burn extends through the entire epidermis and part of the dermis. These injuries are characterized by redness and blisters. The deeper the burn the more prevalent the blisters, which increase in size during the hours immediately following the injury. Like first-degree burns, second-degree injuries may be extremely painful. The development of complications and the course of healing in a second-degree burn depend on the extent of damage to the dermis. Unless they become infected, most superficial second-degree burns heal without complications and with little scarring in 10 to 14 days.

Third-degree, or full-thickness, burns destroy the entire thickness of the skin. The surface of the wound is leathery and may be brown, tan, black, white, or red. There is no pain, because the pain receptors have been obliterated along with the rest of the dermis. Blood vessels, sweat glands, sebaceous glands, and hair follicles are all destroyed in skin that suffers a full-thickness burn. Fluid losses and metabolic disturbances associated with these injuries are grave.

Occasionally burns deeper than a full thickness of the skin are incurred, as when part of the body is entrapped in a flame and not immediately extricated. Electrical burns are usually deep burns. These deep burns frequently go into the subcutaneous tissue and, at times, beyond and into the muscle, fascia, and bone. Such burns are of the fourth degree, also called black (because of the typical colour of the burn), or char, burns. Fourth-degree burns are of grave prognosis, particularly if they involve more than a small portion of the body. In these deep burns toxic materials may be released into the bloodstream. If the char burn involves only a small part of the body, it should be excised down to healthy tissue. If an extremity is involved, amputation may be necessary.

Surgeons measure the area of a burn as a percentage of the body’s total skin area. The skin area on each arm is roughly 9 percent of the body total, as is the skin covering the head and neck. The percentage on each leg is 18, and the percentage on the trunk is 18 on the front and 18 on the back. The percentage of damaged skin affects the chances of survival. Most people can survive a second-degree burn affecting 70 percent of their body area, but few can survive a third-degree burn affecting 50 percent. If the area is down to 20 percent, most people can be saved, though elderly people and infants may fail to survive a 15 percent skin loss.

Severe burns cause immediate nervous shock. The victim grows pale and is confused, anxious, and frightened by the pain and may faint. Much more dangerous is the secondary shock that comes a few hours later. Its chief features are a dramatic fall in blood pressure that leads to pallor, cold extremities, and eventual collapse. This secondary shock is precipitated by loss of fluid from the circulation, not just the fluid lost in the destroyed tissue but fluid that leaks from the damaged area that has lost its protective covering of skin.

Burns kill not just by damaging tissue but by allowing this leakage of fluid and salts. If more than a fifth of the blood volume is lost to the circulation, insufficient blood returns to the heart for it to maintain blood pressure. And the loss of salts, particularly sodium and potassium salts, not only disturbs their balance in the body but changes the osmotic balance of the blood and body fluids. The significance of these physiological changes was understood in 1905, but not until the 1930s were doctors able to correct them with transfusions of blood or plasma.

The treatment of a burn is, of course, dependent upon the severity of the injury. In general, first-degree burns can be adequately treated with proper first-aid measures. Second-degree burns that cover more than 15 percent of an adult’s body or 10 percent of a child’s, or that affect the face, hands, or feet, should receive prompt medical attention, as should all third-degree burns, regardless of size.

Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form | World Journal of Emergency Surgery

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METHODS FOR DETERMINING AREA BURNS

There are a number of ways to determine the size of the burn area. However, most of them are labor intensive and time consuming. In the field, the following are most commonly used:

1. Rule of the palm, the area of which is equal to 1-1.1% of the body surface (meaning the palm of the most affected). The number of palms that fit on the surface of the burn determines the percentage of the affected area, which is especially convenient for limited burns of several areas of the body;

2.Rule of nines – based on the fact that the area of each anatomical region as a percentage is a multiple of nine: head-neck – 9%, upper limb – 9%, lower limbs – 18%, front and back surfaces of the body – 18% each, perineum and genitals – 1%.

These methods are easy to remember and can be used in any setting.

3. Determination of the burn area by segments using the Berkou scheme. Hairy part of the head – 4%, face – 3%, neck – 2%, shoulder – 4%, forearm – 3%, hand – 2%, trunk in front – 18%, trunk in back – 19%, thigh – 9%, lower leg -6%, stop -3%.This method, as it were, details the rule of nines, and it is advisable to apply it when individual segments of the human body are affected.

4. Measurement of the burn area according to G.D. Vilyavin is made using a graphical method using a special card. On the front side of this card, against the background of a millimeter grid, two human silhouettes (front and back surfaces of the body) 17 cm long are drawn, i.e. 10 times less than the average height of a person (1 cm of the area of human skin corresponds to 1 mm on the map).Silhouettes are shaded with colored pencils in accordance with the injured person’s lesions. In yellow – 1st degree burns are hatched; red – 2nd degree burns; in blue with a dashed oblique line – burns of III A degree; in blue solid line – burns of IIIB degree and in black – burns of IV degree. The total number of shaded squares filled within the burn area of each degree is then counted. The data obtained correspond to the size of the burn area on the human body, expressed in square centimeters.The calculation of the affected area is made according to the table printed on the back of the card.

5. Measurement of the burn area according to B.N. Postnikov is that a transparent film is applied to the fired surface, on which the contours of the affected areas are outlined, then the area is measured in cm ², taking into account the total surface area of the human body, which ranges from 16,000 cm ² to 21,000 cm ².

6. Measurement of the burn area using a special stamp proposed by V.A. Dolinin, when each segment on the stamp corresponds to 1% of the body surface.

All burns by area can be divided into 2 groups:

1. Limited burns – when up to 10% of the body surface is affected;

2. Extensive burns – more than 10% of the body surface is affected.

How to measure the area of a palm using a notebook sheet – Common children, Voronezh

The area of the palm of an adult is approximately 1 of the entire surface of the body …

The severity of the burn depends not only on the depth of the lesion, but also on the area of the lesion, which is expressed as a percentage of the surface of the whole body.Small areas of burns are measured with the palm, bringing it to the surface of the lesion. The area of the palm of an adult is approximately 1% of the entire surface of the body. For extensive burns, the area of the skin areas that remain intact is measured with the palm of the hand. The resulting figure is subtracted from 100% and the percentage of skin lesions is obtained. The area of the burn can be measured using the Rule of Nine. According to this rule, the surface of the head and neck is 9% of the area of the entire skin, the surface of the upper limb is 9%, the front surface of the body (chest and abdomen) is 18% (2X9), the back surface of the body is 18%, the surface of one lower limb is 18 %, the surface of the perineum and genitals – about 1%.

In case of burns of the II-IV degree with an area of damage of more than 10-15%, and sometimes with burns of the first degree, if the area of damage exceeds 30-50% of the body surface, burn disease develops. The first period of burn disease is called burn shock.

In burn shock, the affected person is initially agitated, groans, complains of pain, and then depression sets in. Usually, with shock, vomiting, thirst, and a weak, frequent pulse are observed. An important sign of burn shock is a sharp decrease, and sometimes complete cessation of urine output.Burn shock can last 1 to 2 days. During this period, capillary permeability is disturbed, initially in the affected area, and then throughout the body. The liquid part of the blood sweats into the tissue, and in case of second-degree burns – and out through the burn wound. This leads to the loss of proteins, blood thickening, disruption of the water-electrolyte balance. Therefore, those who are burnt in the first 2-3 days need intravenous administration of large amounts of protein and salt blood substitutes. Blood and plasma transfusions are given if possible.The burned sometimes develop life-threatening pulmonary edema, and there is a sharp shortness of breath and bubbling breathing, abundant secretion of mb.

Victims of burn shock are very susceptible to repeated trauma. Careless transportation, cooling and painful irritation of burn wounds lead to aggravation of the condition or recurrence of shock.

A burn shock is followed by a period of acute burn toxemia. During this period, the products of tissue decay are absorbed into the blood from the wounds, and the body temperature rises.Intoxication of the nervous system leads to agitation (insomnia, muscle twitching) or to general depression of the victim. During this period, pneumonia is often observed. Acute burn toxemia is replaced by a period of burn septic flow * s. At this time, suppuration of burn wounds sets in. With extensive deep burns, a burn source is often observed –

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Calculate arm area using depth data

Using a Kinect sensor, I am trying to write a clenched fist detection algorithm. I try to achieve this by calculating the area occupied by the hand (since the area of the clenched fist

This is what I have so far:

Depth information per pixel (from DepthStream)
Hand Location (from SkeletonStream)

I am having a hard time figuring out how to get the depth data corresponding to the arm.It’s easy to get depth data at the exact location the Kinect gives for the arm, but I don’t know how to get all the depth data for the arm. Any suggestions, pseudocode and / or link to tutorials would help.

c #
computer-vision
kinect
kinect-sdk

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Ardatr
May 18, 2014 at 22:35

2 answers

Calculating the area of a circle in Java Baeldung
I need to write a program to calculate the area of a circle and I seem to be fine, except that when I run the program and enter values, the area calculation turns out to be zero.public class Circle {private double radius; private double area; public Circle () {radius = …
Writing to depth buffer from opengl compute shader
Generally, on modern desktop OpenGL hardware, what is the best way to fill a depth buffer from a compute shader and then use that depth buffer to render a graphics pipeline with triangles, etc.? In particular, I am interested in HiZ related problems. Except…

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Florent Gz
May 19, 2014 at 09:54

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Md.Tazbir Ur Rahman Bhuiyan
May 19, 2014 at 02:33

DETERMINATION OF BURN AREA | Experts in the field of medicine

Project author:

Kruglov Sergey Vladimirovich

Kruglov Sergey Vladimirovich , Professor , Doctor of Medical Sciences, Honored Doctor of the Russian Federation, surgeon of the highest qualification category,

More details

Page editor:

Semenisty Maxim Nikolaevich

Leading specialists in the field of burn surgery.

Kasatkin Vadim Fedorovich

Kasatkin Vadim Fedorovich, Professor, Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences, a surgeon of the highest qualification category, Head of the Thoraco-Abdominal Department of the RNIOI, Honored Doctor 902 902

9000

Minasyan Robert Mikhailovich

Minasyan Robert Mikhailovich Surgeon of the highest qualification category

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Mikhail Fedorovich , Honored Doctor of Russia, Professor, Head of the Department of Surgical Diseases No. 4 FPK and PPS RostGMU, g.Rostov-on-Don.

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Treatment of burns and their consequences. V.V. Yudenich.

The severity of the burn depends not only on the depth, but also on the area of the lesion. The simplest and most convenient method for determining the area of the burn is to measure it with the palm of your hand or using the rule of nines. The palm of the affected person is approximately 1% of the surface of his body. Taking this into account, it is possible with a sufficient degree of probability to calculate the area of the burn.

The principle of determining the burn area according to the rule of nines is based on the fact that the entire surface of the body is divided into sections, the area of which is 9% of the body surface. So, the surface of the head is 9%, the front surface of the body is 9X2 = 18%, the back surface of the body is also 18%, the surface of the thigh is 9%, the lower leg with the foot is 9% and the perineum is 1% (Fig. 12).

SCHEME OF DOCUMENTATION OF BURNED BURNS AND MEASUREMENT OF THE AREA OF BURNS BY THE VILYAVIN METHOD

1. N ° of the case history ______________ 2.Date of filling out the scheme ____

3. Surname and initials of the patient _____________________________

4. Date of admission ____________ 5. Date of injury _______________

6. Size of burns by degrees, cm2.1 degree _________, II degree

III degree __________, IV degree _________

7. Total lesion area, cm2 __________________,% _______

8. Sizes of transplanted skin flaps, cm2 _________________

Usually, when measuring the area of the burn, they use both the rule of nines and the rule of the palm.

A number of authors have developed various forms of stamps depicting a person’s silhouette (front and back views), divided into squares. The most widespread was Vilyavin’s scheme (Fig. 13).

The contours of the burn are drawn on the diagram with multi-colored pencils, after which the I degree of the burn is painted over in yellow, II – in red, ITT A – in blue stripes, SB – in solid blue, IV – in black. Knowing the area of the squares that fall into the contours that outline the boundaries of the lesion, it is possible to calculate the area of the burn of each degree and in general in square centimeters, and as a percentage in relation to the entire surface of the body.

DETERMINATION OF THE AREA OF BURN

V. A. Dolinin suggested using a rubber stamp to measure the area of the burn, which shows the silhouettes of a person (front and back surfaces), divided into segments. The anterior surface contains 51 and the posterior 49 equal areas, each of which is approximately 1% of the body surface. The degree of burn is indicated by the corresponding shading (Fig. 14).

It is also convenient to document the depth and area of the burn (fig. 15) by making so-called skits (sketches).

T. Ya.

Sketches are corrected during the treatment of burns; new data are introduced into them, noting the disappearance of healed burns of I and II degrees, the identification of new areas of burns of III-IV degrees, the appearance of wounds closed with grafts, donor sites, etc. , they are not marked.This can be supplemented by additional profile sheaths or sheaths of individual areas of the body (Fig. 16).

Documentation of the area of the burn with scissors. The numbers on the silhouettes indicate the percentage of areas of the body bounded by the lines.

Various types of skits.

It is difficult to predict the severity of the burn and its outcome, especially in the early days, due to the lack of reliable objective signs of the depth of the lesion. Most of these calculations are based on determining the total area of the lesion and a relatively accurate determination of the area of a deep burn.The simplest predictive technique for determining the severity of a burn is the rule of a hundred. If the sum of the numbers indicating the age of the affected person and the total area of the burn approaches 100 or exceeds 100, then the prognosis of thermal injury becomes doubtful or unfavorable. The rule of one hundred can only be used in adults; it does not apply to predicting burns in children.

The predictive index according to the rule of one hundred (age + + total area of the burn) has the following values: up to 60 — the forecast is favorable, 61-80 — the forecast is relatively favorable, 81—100 — dubious, 101 and more — the forecast is unfavorable.

The Frank index (1966) can be used as a universal predictive test that determines the severity and possible outcome of a burn in both adults and children, but to calculate it, you need to know the area of a deep burn. The Frank index is based on the assumption that a deep burn makes the patient’s condition three times worse than a superficial burn, so 1% of a superficial burn is taken as the basic unit, and a deep burn corresponds to three units. For example, the total area of the burn is 35% of the body surface, while 20% is occupied by deep burns, which means that the Frank index will be equal to the area of the superficial burn (35 – 20 = 15) plus three times the value of the area of the deep burn (20 X 3 = 60).The sum of the indicators of the area of superficial and deep burns (15 + 60 = 75) is the Frank index. If the Frank index is less than 30, then the prognosis of the burn is favorable, 30-60 is relatively favorable, 61-90 is doubtful and more than 91 is unfavorable.

The integrity of the skin plays an important role in maintaining homeostasis. The skin takes part in thermoregulation, respiration, metabolism, excretion of metabolic products, it is also a sensory organ, resorption, blood storage, protection, and performs an integumentary function.Burns of the skin, as well as the mucous membrane of the respiratory tract, depending on the depth and extent of the lesion, cause a number of pathological changes in the body, manifested by the clinical picture of burn disease.

Loodusõpetus vene kooli 7.klassile

Except unit area 1 m

the following units are also used:

square

kilo

meter 1

square

deci

meter

square

centi

meter 1

with

square

Milli

meter 1

The area of parcels of land is also often measured in hectares (ha).

1 ha is the area of a square with a side length of 100 m.

Direct and indirect area measurement

The area of a flower bed can be measured in two ways.

In the figure, the plan of the flower bed is plotted on a grid of squares. Side length

square corresponds to 1 m.Thus, each square represents

a unit square with an area of 1 m

…

To measure the area, you need to find out how many squares are covered

given figure. To do this, consider fully and partially covered squares

rats. Fully covered squares 14, partially covered – 8. For

area calculations, the number of partially covered squares is divided by two.

Partially covered squares can be paired so that each

a pair together covers one unit of area.

We get that the flowerbed covers approximately 14 + 8: 2 = 18 squares, which

means that its area is approximately 18 m

…

This way of measuring the area is called

by the method of unit squares –

rats.

Using the unit squares method, the area is measured

direct –

actually

…Direct measurement determines how many times

the measured body is larger than the body taken as a unit of measurement.

Direct (direct) measurement

Is a comparison with a unit of measure.

Area can also be measured

indirectly

… For this, the required

required dimensions, and the area is calculated using the appropriate formulas.

Since the special formula for calculating the area of such a four-

the square does not exist, the flowerbed in the figure is divided into two triangles.

The figure shows the dimensions by which you can calculate the area of each

next to a triangle using the area of a triangle formula.

indirect measurement

the value is calculated

through other measured values.

You can find the formulas for calculating the area in the appendix on p. 129.

SHOULD BE REMEMBERED

With the help of the area, the size of the surface of the body is numerically expressed.

The area is denoted by the letter

… The unit of area is one square meter (1 m

Direct measurement is a comparison with a unit of measurement.

In indirect measurement, other quantities are measured,

and the result is obtained by calculation.

Questions and tasks

1. Name several objects, the area of which is appropriate to express

in square kilometers.

2. Calculate the area of the matchbox edges.

3. Calculate the area of the flower bed according to the data in the lower figure.Compare the result

with the result of direct measurement. Which result is more reliable?

Justify.

100 m

1 hectare

1 ha = 100 m 100 m =

= 10,000 m

1 m

5.4 m

4.0 m

6.7 m

2.4 m

1m 0

Determination of the area of the burn

It is known
a large number of methods.Another
a very important component of the diagnosis
is the definition
burn area by the method of Vilyavin G.D.,
1956; Dolinina
V.A. and others.
which
currently not applicable.

At
treatment of adult patients are used
the two most convenient
to practical application and least
labor intensive.

Palm Rule

Previously
believed that the area of the palm is
about 1-1.1% of the total body area,
there are other data as well. As a result
carried out
anthropometric research
J.Grazer
et al. (1997) concluded that the area
palms in an adult is
0.78% of the total body surface area.
Measure the affected area with the palm of your hand
this burned patient, visually
transferring the area of his palm to the area
burn wound. In practice, it is generally accepted that
taking into account possible error area
palms + fingers of the hand are considered equal
1%.

“Rule
nines “: method A . Wallace
in 1956

At
it is assumed that the area
each anatomical region as a percentage
is a multiple of
9 (fig. 1).

Distribution
parts of the body by area are as follows:

Head and neck – 9%;

Breast – 9%;

Stomach
– nine%;

Back – 9%;

Loin with buttocks
– nine%;

Upper
limbs
make up
9% each;

Each thigh
nine%;

Each
shin and foot 9% each;

Crotch
and
genital
organs – 1%.

Have
children ratios are different.

Necessary
emphasize that absolutely sure
determine the area
burn using both of the above
methods are quite difficult.
Connected
this is
with the following circumstances:

“Rule
nines “in relation to people of different
age. Due to the peculiarities
anatomical structure of the ratio
parts
body
at
people can be different. There are people with
short and long
limbs,
with large and small brushes, with
various
type
physique.Highly
high accuracy in determining the area
no burn needed, and errors within
1-2% of the determined area is quite
are permissible.

Area measurement
burn according to V.A. Dolinin.

Body contours
human being divided into segments, each
of which leaves 1% of the surface
the skin of the body of a given person.

Area
surface (%) of individual anatomical
regions

For
determination of body area in children and
adults can be used
nomogram shown in the figure:

Previously
the SCHEME was used (Fig.1) documentation
burned and measuring the area of burns
to
the method of G.D. Vilyavina ,
But due to the laboriousness of calculating the percentage
maintenance of the affected area in
practical medicine is used
rarely.

except
Moreover, there is a known method for determining
relative area of burns
to
N.N.Blokhin (1953).
According to this method, children are determined
absolute area in cm ²
and then divide it by the coefficient.

V
at the age of 1 year, this coefficient is
thirty; at 2 years old-40; at 3 years old
-50; at 4 years old – 60; at 5-6 years old – 70; at 7-8 years old –
80.From
8 to 15 years old, the coefficient is equal to the age from
zero (for example, 12 years old – 120), and older –
height in centimeters.

Rice. 1

Area
and the depth of the lesion determine the severity
condition patient,
determined most often
Frank index.

At
defining this indicator
every percentage of superficial burn
(I-Sha
degree) are estimated
as 1 point and every percentage of deep
defeat (Shb – IV
Art. ) – as 3 points.

Index
severity of injury (ITP)
allows more accurate
assess the severity of thermal injury.It is calculated as follows
way: every percentage of burn I
Art. taken for 0.5 points;
II
Art. – for 1 point; Sha Art. – for 2 points; Shb st.-
for 3 points and IV
degree – for 4 points.

Received
when determining the specified indices
the amount reflects
the severity of the injury, allows
predict the likelihood of occurrence
and the severity of the course of burn shock.

Burn
shock I
degree develops if the sum of the points
ranges from 30 to 70. Burn shock II
degree has
a place
at a value
amounts from 71 to 130.Extremely severe shock
(III
degree) – over 130.

Have
old people, weakened people and children
burn shock occurs with less
values of the sum of predictive
indices.
It is necessary
note that inhalation lesions
substantially
burden
the course of thermal injury.

Thermal inhalation
defeat

Flame,
hot air and combustion products at
confined space fires
(dugouts), military equipment and in the hearths
use of combat
fire mixtures often affect organs
breathing.Hot inhalation
air after a few hours
marked swelling of the mucous membrane
oral cavity and subglottic
space with the development of mechanical
asphyxia.

Distinguish
burns
upper respiratory tract, spreading
from
mucous membrane of the lips and anterior
parts of the nasal passages to the larynx
and thermochemical
respiratory tract damage by products
burning
(more often
total compounds of carbon and nitrogen),
extending to
the entire respiratory tract. Both forms
defeat, as the case may be
injuries, can occur in isolation,
however more often they
are combined.A feature of thermal
respiratory tract injuries
is the toxic effect of particles
soot that settles on the mucous membrane
the membrane of the trachea and bronchi and can cause
necrosis of epithelial cells.

Diagnostics
respiratory tract damage is based
on clarification
circumstances of the injury and clinical
examination of the affected.
Thermal inhalation lesions of organs
breaths are most often combined
with burns of the face, head, neck, front
chest wall. In case of poisoning with oxide
carbon (or other toxic
combustion products)
affected may be unconscious
condition.On examination
shedding of nasal hairs is revealed
strokes, hoarse voice, cough (dry or
with the release of black sputum),
difficulty breathing
hyperemia and smoke of the mucous membrane
membranes of the mouth and nasopharynx. Credible
diagnosis of the severity of mucosal lesions
tracheal sheath
and bronchi is possible when using
fibrobronchoscopy or early
diagnosis of inhalation lesions
more accurate methods include
lung scan with Xe
133.

V
clinical course of thermal inhalation
defeat follows
making a difference
three stages.

I
stage
(6-24
hours) – the leading mechanism initially
is generalized bronchospasm.
Soon
is developing
edema of the tracheobronchial mucosa
tree leading
to a significant deterioration of the pulmonary
ventilation. For burns of the larynx with
violation of its patency, already in the early
terms appear
signs of mechanical asphyxia.

II
stage
(24-36
hours from the moment of injury)
– may manifest as pulmonary edema,
due to violations
blood circulation in a small circle and
bronchospasm.In the lungs there are
multiple foci of microatelectasis
and emphysema leading to
further disturbance of ventilation .

III
stage
(with
2-3 days) is characterized by
development of inflammatory changes
(purulent tracheobronchitis, pneumonia).
With respiratory tract damage in 70-90%
patients have pneumonia, and
developing disorders of gas exchange
cause the death of 20% of these
amazed.

Degree of severity
thermal inhalation lesions

Can
consider that respiratory damage
ways renders
on the victim the same action as
and deep
burn, with an area of 10-15% of the body surface.

Distinguish
three degrees of thermal injury
respiratory
ways (according to L. M. Klyachkin):

I
degree.
Moderate respiratory distress,
cyanosis
absent, voice saved. In the lungs
can be heard
dry wheezing. If pneumonia develops,
then it flows
easily. The prognosis is favorable.

II
degree.
Respiratory disorders manifest
for the first time 6 – 12 hours. Respiratory disorders
pronounced clearly,
cyanosis, there may be hoarseness of the voice.Pneumonia
develop almost always and differ
lingering current.
There is pulmonary heart failure
I-II
degree.
The prognosis is serious.

W degree.
Respiratory disorders reach extreme
degree, threatening asphyxiation. Are characteristic
shortness of breath, frequent cough with discharge
viscous sputum. Can be observed
aphonia. Signs are pronounced
pulmonary heart failure.
Pneumonias come on early and run on
hard, due to blockage of the bronchi
acute emphysema and atelectasis develops.The prognosis is bad. In the terminal period
pulmonary edema develops with a characteristic
gurgling breath.

Rule
“Hundreds” and Bo index
allowing
predict the outcome of an injury. These
indicators are very close
inherently and reflect the likelihood
survival or death of the patient. These
indexes are applicable for adults only
patients. When determining them, calculate
the sum of the total area of the burn and age
victim.

If this amount is up to
60 – the prognosis is favorable;

Amount 60 -80 – forecast
relatively favorable;

Amount 80 – 100 –
the forecast is doubtful;

Sum
more than 100 – the prognosis is unfavorable.

How
closer this
sum
to 100 – the greater the likelihood of death

Burns: classification, consequences, first aid

Thermal skin burns are more common than others.

Chemical burns of the mucous membrane of the eyes, mouth, esophagus, stomach, respiratory tract, skin and other organs. arise as a result of the ingress of acids, alkalis and other toxic substances on them.

Radiation burns result from exposure to ionizing radiation.

Depending on the depth of tissue damage, four degrees of thermal burns are distinguished:

I degree – hyperemia (overflow with blood) and edema of the skin;

II degree – blistering;

IIIIA degree – skin lesion, in which, under favorable conditions, independent epithelialization of the burn is possible – new skin forms on the affected areas;

SB degree – necrosis (death) of all layers of the skin;

IV degree – damage other than the skin of the subcutaneous tissue, muscles, bones.

Burns of I, II and III degrees are superficial burns, burns of III and IV degrees are deep. Most of those affected usually have a combination of burns of varying degrees.

Deep burns are characterized by a change in skin color (deathly pale color, charring) and tissue compaction with the appearance of a pronounced pattern of saphenous veins. With deep burns, pain and tactile (tactile) sensitivity is lost. Superficial burns are accompanied by severe pain.Most often, the depth of the burn can be established only after five to seven days, since these days there is a deepening of necrosis in the burn zone.

The area of the burn is usually expressed as a percentage of the total surface of the skin. The most widespread methods of determining the area of burns – the rule of “nines” and the method of the palm. According to the rule of nines, the surface of the head and neck is 9%, the upper limb is 9%, the front surface of the body is 18%, the back of the trunk is 18%, the lower limb is 18%, the perineum and external genital organs are 1% of the entire surface of the body. …

The area of the palm of an adult is approximately 1% of the total surface of the body. With limited lesions with the palm, measure the area of the burn, and with large lesions – the area of unaffected areas of the body.

If the area of the II-III-IV degree burn exceeds 10-15% of the body surface, the victim develops a burn disease. Its severity depends on the area and depth of the burn, the age of the victim, the presence of complications and concomitant diseases.

During burn disease, four periods are distinguished – burn shock, acute burn toxemia, burn septicotoxemia and convalescence.

Burn shock develops with a thermal burn that affects more than 15% of the body surface, and in persons over 60 years of age – with less extensive lesions. It is characterized by the appearance of edema (especially pronounced in the burn areas), a decrease in the volume of circulating blood, its thickening and a slowdown in blood flow.

Circulatory disorders cause dysfunctions of internal organs, primarily of the kidneys and liver, as a result of which the victims often develop acute renal failure, and sometimes liver failure.Blood pressure may increase, tachycardia is noted.

The body temperature is lowered. Vomiting and thirst are often observed. The course of the burn shock worsens with cooling of the patient, late and incorrect anti-shock therapy, long-term transportation. The duration of the burn shock ranges from several hours to two to three days.

Acute burns Toxemia develops as a result of protein breakdown products and toxic substances entering the body from the burn surface.The beginning of this period is characterized by the onset of fever. Tachycardia, poor appetite, sometimes vomiting, insomnia are noted, which remain especially pronounced in the first 10-14 days after the burn. With an extremely severe course of burn toxemia, the signs of acute psychosis come to the fore, manifested by disorientation, agitation, hallucinations and delirium.

With burns septicotoxemia , suppuration of wounds and rejection of a burn scab occur. There is a purulent-resorptive fever with a daily temperature range of 2-2.5 degrees, insomnia, lack of appetite, weight loss.In severe cases, septicotoxemia is complicated by pneumonia, erosive and ulcerative lesions of the gastrointestinal tract, hepatitis, sepsis.

An extremely serious complication is burn exhaustion, which is manifested by the cessation of recovery processes and progressive necrosis in wounds, sharp weight loss, anemia (anemia). Burns are often fatal. Sometimes purulent inflammation of soft tissues, erysipelas, thrombophlebitis, phlegmon, arthritis develop.

In the fourth period – convalescence – there is a gradual healing of burn wounds, engraftment of skin grafts (transplanted sites), restoration of the function of internal organs, hematopoietic system, metabolic processes and more.

First aid for burns – cessation of the effect of the damaging factor. In case of minor burns of I and II degrees, you should hold the burned area in cool water or apply a wet cold compress. The action of cold water helps to stop the process of damage to skin and tissues.

Cover all burns with a clean, dry cloth, and use over-the-counter products to relieve pain and irritation.

In case of burns by a flame, extinguish the burning clothes, take the victim out of the zone of high temperature; in case of burns by hot liquids, molten metal – quickly remove clothing from the burned area.

It is advisable to immerse the burned parts of the body in cold water or wash with a stream of water from the water supply for 5-10 minutes.

If the burn area exceeds 15% of the body surface, it is necessary to give the victim to drink at least 0.5 liters of water with baking soda and table salt – 1/2 teaspoon of baking soda and one teaspoon of salt per liter of water.

Aseptic dressings should be applied to the burned surfaces, the victim should be urgently taken to a hospital.

In order to prevent disability and death of persons with severe burns, the specialized care provided to them must correspond to the severity of the injury. There are three levels of such care – in non-specialized hospitals, in burn departments and in burn centers.

Non-specialized medical institutions provide assistance to people with moderate burns. It is provided in hospitals that do not have special equipment for treating burns, but have one or more experienced doctors on the staff to deal with this problem.

As the severity of burns increases, specialized care is needed in burn departments and centers that are equipped with the necessary equipment.

Based on open source information

Estimating record size

Topic overview

You can quickly estimate record size using the rule of nines. This method divides the body surface area by a percentage.

Estimated adult burn size

Image of the “rule of nines” for adults.

The front and back of the head and neck account for 9% of the body surface area.
The front and back of each arm and hand equal 9% of the body surface area.
The chest accounts for 9% and the abdomen 9% of the body surface area.
The upper back is equal to 9% and the lower back is equal to 9% of the body surface area.
The front and back of each leg and foot account for 18% of the body surface area.
The groin area is 1% of the body surface area.

Estimating Infant and Young Child Burn Size

See Infant and Young Child Rule of Nines Image.

The front and back of the head and neck account for 21% of the body surface area.
The front and back of each arm and hand represent 10% of the body surface area.
The chest and abdomen make up 13% of the body surface.
The back makes up 13% of the body surface.
The buttocks make up 5% of the body surface.
The front and back of each leg and foot account for 13.5% of the body surface area.
The groin area is 1% of the body surface area.

The Rule of the Palm is another way to estimate the size of a burn. A burned person’s palm (not fingers or wrist area) makes up about 1% of the body. Use the palm of a person to measure the area of the burned surface of the body.

Difficult to estimate the size of the burn. If you think the burn is a certain size but are not sure, it is best to discuss the size of the burn with your doctor.

Loans

Current as of:
February 26, 2020

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr., M.D., FACEP – Emergency Medicine
Adam Husney M.D. – Family Medicine
Kathleen Romito M.D., Family Medicine
H.Michael O’Connor MD – Emergency Medicine
Martin J. Gabika MD – Family Medicine

As of February 26, 2020

Author:
Healthy staff

Medical Review: William H. Blahd Jr., M.D., FACEP – Emergency Medicine and Adam Husney, M.D. – Family Medicine, and Kathleen Romito, M.D. – Family Medicine, and H. Michael O’Connor, M.D. – Emergency Medicine and Martin J. Gabika, MD – Family Medicine

(PDF) Surface area of the hand and palm to estimate the percentage of total body surface area: meta-analysis results

adults, PSA score 0-5% TBSA may be more practical and accurate tool for estimating surface area.If the HSA is

to be used for adults, the estimate for males should be 0-9%

and for females 0-85%. However, these values will depend on BMI and ethnicity. Children’s HSA is

approximately 1.36% TBSA and PSA is 0-63% TBSA.

are differences between children of different ages, and alternative methods for estimating surface area may be required for

children.

We believe that the TBSA percentage estimate

is so widely used in many different contexts that it is inappropriate for authors to draw any broadly applicable conclusions

about the clinical impact of imprecision.For children,

is a lack of data, but the inaccuracy seems to be large. The likelihood of adverse consequences for

is greatest for

children, and further investigation of this group is warranted.

Discontinuity can be eliminated by constructing no-

mograms, which correct the gender, body weight and ethnic group of the

object being assessed, and we intend to follow this approach

Further research is needed to address the lack of data

for many ethnic groups, primarily Africans.When further studies

are reported, authors should clearly describe their definition of hand and / or palm, use clinically applicable methods

to assess HSA, PSA, and TBSA, and provide data for subjects

for age, gender, race, and BMI.

References

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were transferred to the regional checked burn center. Ann Plast Surg 2003; 51: 173-6.

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ability to estimate the size of burns from different drawings

burn area diagrams. Burns 2000; 26: 156-70.

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2009; 35: 757-67.

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bal Assessment and Lattice System Physician’s Global Assessment.

Br J Dermatol 2006; 155: 707-13.

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Oxford: Blackwell Publishing Company, 2002.

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Can Fam Physician 1993; 39: 2394-400.

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on approximately 1% of the body surface area.Br J Dermatol 2011; 164: 665-

83.

16 Yu CY, Hsu YW, Chen CY. Determination of the surface area of the hand as

percent of the body surface area by 3D anthropometry. Burns

2008; 34: 1183-9.

17 Amirsheybani HR, Crecelius GM, Timothy NH et al. Natural growth history of the hand

: I. The area of the hand as a percentage of the

body surface area. Plast Reconstr Surg 2001; 107: 726-33.

18 Nagel TR, Schunk JE.Using your hand, estimate the burn area

–

in children. Pediatr Emerg Care 1997; 13: 254-5.

19 Lee JY, Choi JW, Kim H. Determination of the surface area of the hand from

gender and body shape using alginate. J Physiol Anthropol 2007;

26: 475-83.

20 Berry M.G., Evison D., Roberts A.H. The effect of body mass index

on the area of the burned surface is assessed by the area of the hand.

Burns 2001; 27: 591-4.

21 Dicks J.J., Altman D.G., Bradburn M.J. Statistical methods for investigating heterogeneity

and combining the results of several studies into a meta-analysis

. In: Systematic Reviews in Health Care: Meta-Analysis in Con-

text (Egger M, Smith DG, Altman DG, eds), 2nd ed. London: BMJ

Publishing Group, 2008; chapter 15.

22 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin

Tests 1986; 7: 177–88.

23 Efron B, Tibshirani RJ. Bootstrap measures standard errors,

confidence intervals, and other measures of statistical accuracy. Statistical Science 1981; 1: 54-77.

24 StataCorp. Statistical software Stata: Issue 11. College Station,

TX: StataCorp LP, 2009.

25 Long C, Finlay A, Averill R. Hand rule: 4 hand areas = 2

FTU = 1g. Arch Dermatol 1992; 128: 1129-30.

26 Sheridan R., Petras L., Basha G. et al. Planimetric examination

Percentage of body surface represented by hand and palm: Determination of the size of irregular burns

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: Inconsistency investigated and re-evaluated. BMJ

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to estimate the surface area of the hands of Chinese adults. Burns 2008;

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body surface area in the population of India. Indian J Plast Surg 2010;

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in Korean children using the alginate method. Statement

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British Journal of Dermatology (2013) 169, pp. 76–84

Surface area of the hand and palm as a percentage of BSA, J. Rhodes et al. 83

(PDF) Determination of the surface area of the palm and palm as the ratio of body surface area in the population of India

Moreover, the ratio of the palms in adult men and women was

0.49% and 0.51%, respectively, with a significant difference

between a man and a woman.Rossiter [10] also found a significant difference in the ratio of palms

in males and

in females.

In our study, the ratio of hands in children was 1.065%, while

there was no significant difference between men and women, as

compared to 0.94% according to Nagel [11] and 0.82% according to Perry [ 9] and

0.87% in children. study of Amirsheibani. [6] The ratio of palms

in children in our study was 0.635% without a significant difference

between men and women compared to

0.52% according to Nagel [11] and 0.45% in the Perry study [9].

Amirsheybani [6] used an integrated planimeter to calculate the

area of palms and palms from 800 Caucasians.

volunteers aged 2 to 89 years. The BSA was

, determined using the Dubois and Gehan and George formula

. The palmar surface of the hand corresponds to

0.78 ± 0.08 percent BSA in adults. In children

the palmar surface of the hand was 0.87 ± 0.06.

Perry [9] examined 20 adults and 10 children (age

years without documents). BSA was calculated by Gehan and George’s method

. The projection area of the hand

, determined using a computer program. Among

adults, the average values of the area of the palm and the entire surface of the hand

with a 95% confidence interval were 0.41% (0.37-0.43),

and 0.77% (0.74-0.80) respectively. Among the

children, the corresponding values were 0.45% (from 0.42 to 0.48%) and

0.82% (from 0.78 to 0.87%). For the two groups, combined in

, the average projected area of the entire arm was 0.79% (from 0.76 to 0

, 81%).

Rossiter [10] also published a study of 70 adults (36 males and 34

females) adult subjects in which the TBSA was calculated from the standard nomogram

and the surface area of the hand was

using the hand outline drawn on the plot section.paper. The areas of

were calculated by counting the squares enclosed by the contours of

and found that the average area of 

palm trees was 0.52% and 0.43% TBSA in males and females,

respectively. The average hand area was 0.81% for men

and 0.67% for women.

Nagel [11] calculated the TBSA from the standard nomogram

, and the area of the hand and palm was calculated using a photocopy of the hand

.They found that 91 children

had an average hand area of 0.94% (95% CI) and a palm area

was 0.52% (95% CI) TBSA.

Sheridan [12] measured the palmar surface of the hand in

69 patients. They concluded that the palm surface of

averaged 0.52% TBSA, and the palmar surface

had 0.85% TBSA. However, they did not find any correlation of

with age or gender.

It is evident from this study that using only the surface area of the hand

will overestimate the size of the burn.For a more accurate estimate of

, the resulting area should be

times 0.9 for adults. We used a simple hand tracing

to determine the palm / palm area

because it is a simple and convenient method and

is within 2% of the hand area measured by the integrated planimeter

[6]. ] Therefore, you may not need the built-in planimeter

, computer methods or the complex

scale to measure the area of the arm.We also used the dominant hand tracing

to measure the area, because

does not have a significant difference between the areas of the two

hands. [6] In children, ages ranged from 2-17 years

, because studies have shown that the

hand region maintains a fairly constant percentage of BSA throughout the

–

growth process in the same age range. [6] The limitation of the

study is that hand / palm surface area estimates of

and BSA are calculated using the height and weight nomogram

and is indirectly related to the accuracy of the formula and the potential for subjective errors

.The human body has three dimensions

and there is currently no practical method

for measuring three-dimensional body surface area.

Using the surface area of the patient’s hand is a simple method from

to estimate the size of a burn or injury, especially for small focal burns

and extensive burns where the unburned area

can be calculated manually. The results show that

of the whole palm, rather than the palm, is more consistent with 1%

TBSA.

CONCLUSION

The average area of the hand in an adult was 139.462 ± 16.21 cm2, and

in a child – 85.646 ± 21.11 cm2. The average palm area

in adults and children was 75.756 ± 9.938 cm2 and

50.675 ± 12.603 cm2, respectively. In our study, the average hand ratio

in adults was 0.921 ± 0.088, and in children

– 1.065 ± 0.110. In many studies conducted in Western countries

, the ratio of arm area to TBSA is

about 0.eight%. This may be due to the decrease in the TBSA Indian population of

compared to their western counterpart.

The average ratio of palms in adults was 0.502 ± 0.065, and in children

it was 0.632 ± 0.084. The ratio of palm trees in the western population

for adults and children was 0.4% and 0.5%, respectively. We

Agarwal and Sahu: Palm to palm area as a ratio of TBSA

Indian J Plast Surg January-June 2010 Volume 43 Issue 1 52

Hand Safety Selection – CPWR

There are several ways to determine the size of the handle:

1.Experiment . Take a tool you already own with a handle that looks a little too small, and wrap some tape around the handle where you hold the most. Use the product within 24 hours. Keep adding tape until it feels too big, then peel off a few tapes until it feels comfortable. Wrap a tape measure around the area you taped to select the pen size that works best for you.

2.Measure the diameter of the hand grip and use it to calculate the grip size .

Use hand size . At 20% of , the length of your arm is equal to the diameter of the handle. EXAMPLE : 20% of a 7-1 / 4 “(or 7.25”) arm is approximately 1-1 / 2 “( is calculated as follows: : 7.25″ x 0.20 = 1.45 ” – rounds to 1.5 inches))
OR
Use test OK .Make an OK sign with your thumb and forefinger, and then measure the inside of the O to find the diameter. In Photo 2, for example, the arm is about 1-1 / 2 “(or 1.5”) in diameter.

Knowing the diameter of the grip of the hand, the size of the grip can be calculated by multiplying the diameter of the grip by 3.14. EXAMPLE : An arm with a 1-1 / 2 “(or 1.5”) grip would have a grip size of approximately 4-3 / 4 “( is calculated as follows: : 1.5″ x 3.14 = 4 , 7 inches)

3.Rely on Research . The National Institute for Occupational Safety and Health (NIOSH) offers a range of handle diameters from 1-1 / 4 “to 2”. These sizes correspond to grip sizes from approximately 3.9 “to 6.3” for “power grip”. If your arm is longer, choose a larger grip size. If your arm is shorter, choose a smaller grip size.

TIP
There are two easy-to-use online calculators that can help:
“Calculating the Area of Circles – Online Calculator” calculates the size of the grip (circumference) – just enter the arm diameter and press “Solve the rest” .
“Decimal Fraction Calculator with Equivalent Table” allows you to quickly convert decimal fractions to fractions or fractions to decimals.

Coverage. Grip span is the distance between thumb and toes when the tool jaws are open or closed.

To calculate the strongest grip interval, measure your wide-spread arm from the tip of the thumb to the tip of the little finger in centimeters (cm) (Photo 3), divide that number by 5 and add 1.5 cm.For example, if your open palm is 18 cm from the tip of your little finger to the tip of your thumb, then your strongest grip would be approximately 5.1 cm or 2 inches (calculation: 18 cm divided by 5 = 3.6 cm; 3. 6 cm + 1.5 cm = 5.1 cm or about 2 inches.) (This online metric conversion calculator easily converts centimeters to inches.)

2.7: Body surface area – Physics LibreTexts

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Reinforcement activation

Surface area ( A ) is an important characteristic of the human body.Surface area affects the rate at which heat is transferred into or out of the body, as well as the rate at which certain chemicals can be absorbed through the skin. The severity of burn injuries depends on the severity of the burn, as well as on the percentage of the total area of the affected body surface. The area and surface area of geometric shapes can be found using various formulas, for example, for triangles. The surface area of a sinuous shape like the human body is difficult to measure, but we can use the typical ratios of (proportions) to quickly approximate body surface area.For example, the surface area of the palm can be easily measured, and the ratio of the surface area of the palm to the surface area of the body is usually 1/200, which can also be written as 1: 200, 0.005, or 0.5%. The units of area are units of length squared, for example square meters (square meters or m ² ). We need to be careful when converting units that include powers (squared, cube, etc.), and the chain link method allows us to make sure our units are reversed correctly.

Example \ (\ PageIndex {1} \): Example of square inches to square feet.

Let’s replace the carpet in the room. The carpet sells per square foot, so we are trying to figure out the area of the carpet in the room. {2} \ nonumber \]

Strengthening activities

Measure the length and width of the palm in cm . Then calculate the surface area of the palm in units of cm ² . Then calculate your approximate body surface area in units of cm ². Finally, use the chain link method to convert your body surface area to square inches ( to ² ) and m ² .

Taking Measurements: How Big Is Your Hand? | Activity

What you need:

Paper clips or tape measure
1 graph paper per person
Two small bowls
Lima or red beans
1 wide-mouth glass jar
Water
Permanent marker or masking tape
Blank sheet to write
Pencil or markers

What are you doing:

Ask your child if they can think of a reason why it might be important to know their hand size.Your child may mention that knowing your hand size is important when shopping for gloves or mittens.
Show your child the measuring tools you have assembled and tell him that he will measure his hand in 4 different ways. Place a heading on the notation sheet: “My Hand Size”. Divide the writing sheet into 4 parts and mark them as indicated: length, area, capacity and volume.
Measuring Length : Use paper clips to make a chain of paper clips, or use a tape measure to measure the length of your child’s right arm.Start at the wrist and end with the tip of your longest finger. Count the number of paper clips or inches if using a tape measure. Record the information in the log.
Measurement area : Use graph paper for this part of the exercise. Help your child place his right hand on the graph paper, palm down, and close his fingers. Circle his closed hand with a pencil or marker. Help your child count how many squares his hand covers. Discuss the partial square counting method.For example, if most of a square is covered, does that count as one? Or can you combine 2 halves of a square into one whole square? Record the information in the log.
Measuring ability : Fill one small bowl with beans. Have your child pick up a handful of beans and see how much they can hold in their right hand without dropping a single one. Ask your child to dump the beans into an empty bowl and count them to find out how many beans he can hold in his hand or how many grains he can hold in his right hand.Record the information in the log.
Volume Measurement : Pour some water into a glass jar and mark the waterline with a piece of masking tape or permanent marker. Tell your child to make a fist in his right hand. Submerge his fist in water up to the wrist and record the new waterline with duct tape. The amount of water between the two lines is a measure of your child’s fist volume. Try pouring this amount into a measuring cup to see the volume of your child’s fist in fluid ounces.Record the information in the log.
Invite your child to ponder on a piece of paper by writing down their observations after four hand measurements.

Ask your child to measure their left arm and compare. Are both hands the same size? You can also encourage your child to help another family member take the same four measurements. Compare the results with his results: Did the family member with the larger hand have a hand smaller or larger than your first grader?

How the landscaping business measures a palm tree

Ever bought a palm tree and thought, “It looks taller (or shorter) than I thought!”

You may be right.Palms are measured in different ways and sizes can vary depending on the method used. Before buying, it is important to understand how the company you are buying from determines the size of their trees.

Serum albumin

Serum albumin is a protein that makes up 60% of the total amount of plasma proteins. Its main functions are: maintenance of oncotic blood pressure, transport of various chemicals and participation in metabolic processes.

Synonyms Russian

Human albumin.

English synonyms

Albumin, ALB, Protein, Blood.

Research method

BCG method (bromcresol green).

Units

G / L (grams per liter).

What kind of biomaterial can be used for research?

Venous blood.

How to properly prepare for the study?

Do not eat for 12 hours before testing.
Eliminate physical and emotional stress 30 minutes before the study.
Do not smoke within 30 minutes prior to examination.

General information about the study

Serum albumin are the main blood proteins and make up 60% of the total amount of plasma proteins. They are synthesized in the liver (about 15 g per day). Their main functions are: maintenance of oncotic pressure in blood serum, transport of various biologically active substances, including hormones, vitamins.

Albumin binds cholesterol, bilirubin, calcium, and many medicinal substances. In addition, they can serve as sources of amino acids when they are insufficiently supplied to the body.

Serum albumin test is mainly used to assess protein-synthetic liver function and nutritional status.

What is the research used for?

To assess the protein-synthetic function of the liver.
To assess nutritional status.
For differential diagnosis of edema syndrome.

When is the study scheduled?

For chronic liver and kidney diseases.
For severe injuries and burns.
For oncological diseases.

What do the results mean?

Reference values 

Age	Reference values
	28 – 44 g / l
4 days – 14 years	38 – 54 g / l
14 – 18 years old	32 – 45 g / l
> 18 years old	35 – 52 g / l

Reasons for a decrease in albumin levels

Kidney disease (nephrotic syndrome).
Protein-synthetic deficiency in severe liver damage: (cirrhosis, terminal stages of hepatitis).
Burns.
Extensive soft tissue injuries.
Sepsis.
Cancer diseases.
Thyrotoxicosis.
Rheumatic diseases.
Idiopathic hypoalbuminemia in newborns due to immaturity of liver cells.
Decreased synthesis of albumin in the liver due to insufficient intake of proteins from food (fasting, malabsorption), chronic liver disease, long-term treatment with corticosteroids.
Insufficient intake of amino acids due to malabsorption (with enteritis, enterocolitis, pancreatitis).
Increased loss of albumin (with kidney disease, burns, exudative effusions, bleeding, diabetes mellitus, ascites).
Hyperhydration.
Pregnancy (due to hemodilution).

Reasons for an increase in albumin levels

Dehydration (dehydration).

Also recommended

Who orders the study?

Therapist, general practitioner, pediatrician, cardiologist, nephrologist, gastroenterologist (hepatologist), surgeon, anesthesiologist-resuscitator, nutritionist.

Literature

V.M. Lifshits Biochemical analyzes in the clinic: a reference book / V.M. Lifshits, V.I. Sidelnikov; 2nd ed. – M.: Medical Information Agency, 2001. – 303 p.
Nazarenko G.I. Clinical assessment of laboratory research results / G.I. Nazarenko, A.A. Kishkun – M.: Medicine, 2006 – 543 p.

Environmental disaster in Kamchatka: what is wrong with the authorities’ versions?

Maria Kiseleva, Ekaterina Sedlyarova
BBC

October 5, 2020

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Video caption,

Experts call the incident an ecological disaster …

Toxins got into the ocean on the coast of Kamchatka, as a result of which marine animals died and people received burns. The authorities have different versions of what is happening. But most of these versions raise doubts among ecologists.

The authorities of Kamchatka and federal authorities on Monday tried to explain what happened over the weekend in Kamchatka: hundreds of dead sea animals were washed ashore, and before that, local residents and surfers reported burns and poisoning. The authorities’ versions changed, and environmentalists criticized them.

According to the Federal Ministry of Natural Resources and Environment, on October 4, the content of hazardous substances in Avacha Bay (it is an hour’s drive from Petropavlovsk-Kamchatsky) exceeded the maximum permissible concentration (MPC) by only 1.2 times. At the same time, the excess of the MPC of hazardous substances was recorded only on the territory of the bay, and not on the Khaltyrsky beach, the Ministry of Natural Resources said. It was after swimming on Khaltyrsky beach that local surfers complained of poisoning.

Already as of October 5, preliminary test results do not show significant excess of the norm, the ministry said on Monday.

On Monday, the head of the Ministry of Natural Resources Dmitry Kobylkin clarified that no excess of the maximum permissible concentration for oil products was found in places of pollution in Kamchatka. He clarified that the samples contain excess for iron and phosphates, but they are insignificant.

“We did not find any chemical reagents in water. Neither in water, nor on land,” added Kobylkin.

At the same time, environmentalists from GreenPeace, who on Sunday went on an expedition to Kamchatka, said that they found a spot on the ocean water, which is moving to the south of Kamchatka.GreenPeace believes it is heading towards the Volcanoes of Kamchatka UN World Heritage Site. The environmentalists’ photographs show yellow foam on the water.

Photo author, nna Strelchenko / TASS

On Monday morning, the Governor of the Kamchatka Territory Vladimir Solodov outlined three versions that, in his opinion, could lead to ocean pollution. According to him, pollution could be associated not only with man-made, but also natural causes.

Behavior of algae during a storm

One of the natural factors, according to Solodov, is the release of a large number of algae onto the shore during a storm.

“With the behavior of, so to speak, algae, which were carried to the coastline during a storm,” the governor told Interfax, without explaining how algae could cause serious pollution. The Ministry of Nature tried to explain this.

Its head Dmitry Kobylkin said on Monday that some of the samples were delivered to Moscow for analysis. As the minister emphasized, the pollution that occurred in Kamchatka is not of a technogenic nature.

“There is a second version – natural.Our Academy of Sciences says that during this period of time, during storms, any phenomena associated with an increase in toxicity occur, “the minister added. disaster has occurred, the highest level of toxins produced by algae. These substances have a neuroparalytic effect on warm-blooded animals. Also, during the mass development of microalgae, the amount of oxygen in the water layers is sharply reduced, he added.

In theory, algae can multiply – in this case, the level of dissolved oxygen in the water really drops, explains the independent ecologist Georgy Kavanosyan. According to Kavanosyan, this is one of the versions, but unlikely. The reason is that the plume is clearly visible in the images from space – and this, rather, looks like the release of a certain substance, which is very different in density from sea water.

Volcanoes and faults

A version associated with seismic activity on the peninsula, with the activity of volcanoes is also being worked out, Solodov said on Monday.

Head of the Laboratory of Seismic Tomography, Institute of Petroleum Geology and Geophysics named after A.A. Trofimuka (Novosibirsk) Ivan Kulakov said that he was not aware of cases when the release of toxic substances during the hydrothermal activity of the volcano was so huge that it would be enough to pollute a significant area of the water area.

“Volcanoes contain phenols and oil products, the discovery of which is reported in the press, only in microscopic quantities,” said Kulakov (quoted by Interfax).

Photo author, Anna Strelchenko / TASS

Caption to photo,

Hundreds of dead sea animals were found on the beach in Kamchatka over the weekend

Independent ecologist Georgy Kavanosyan considers this version possible: That is, in principle, any eruption or earthquake is the movement of magma, which is accompanied by intrusions, including underwater intrusions, outflows of gases, which, in turn, mixing with water, form acids. “

According to him, on September 15, there was an earthquake of magnitude 6. “This could have provoked the emergence of these rocks – this is the first non-anthropogenic version. It, in principle, beats until proven otherwise,” he said. It is simple to check it: you just need to measure the acidity of the water in the contaminated area.

“Pollution can be associated with many factors, it is necessary to investigate it more closely, and also take into account the fact that such” natural processes “have not been observed in Kamchatka before, and there is evidence that deep-sea spots are moving,” says Violetta Rebko, head of the GreenPeace media department …

Technogenic pollution

In addition to external causes, Solodov named technogenic pollution. Russian Minister of Natural Resources Dmitry Kobylkin later said that his department, together with the Prosecutor General’s Office, is inspecting enterprises in the area of the spill, although they consider the pollution to be natural.

There are many dangerous objects near the coast – these are, in particular, bays with naval ships, tank and other military training grounds, as well as Kozelsky training ground with chemicals and pesticides, Novaya Gazeta noted.

At one of the military training grounds – Radyginsky – firing and tests are regularly held. The latter took place in mid-August.

On October 6, a special commission is to examine the territories of the Kozelsk pesticide landfill and the Radygin landfill. This was announced by the Governor of the Kamchatka Territory Vladimir Solodov during a briefing with journalists.

According to him, these objects are “often referred to in different versions.” He says that both landfills are regularly examined by the Ministry of Natural Resources and the Rospotrebnadzor of the Kamchatka Territory, and these surveys did not reveal any violations.

Ecologist Dmitry Lisitsyn wrote on Facebook that flood waters flow from the Radygino landfill into the ocean north of the surfer camp, where there are many infected. He writes about the disposal of 300 tons of toxic fuel at the landfill.

Kavanosyan does not believe in the version that the propellant has leaked out of the tanks.

“It may be a submarine. There is a submarine base nearby. We will never know this – it’s all classified and thank God – perhaps some submarine suffered some kind of accident or there were some malfunctions and it could throw away the liquid, for example, the solution that is in the battery, “explains Kavanosyan.

But such pollution is also possible from rocket fuel, he said. “It is very toxic to marine life, the first class of hazard. Plus it is quite difficult to detect – conventional chemical analyzes do not detect it,” adds the ecologist. For this, he said, a mass spectrograph is needed.

There is still no understanding of the reasons for water pollution in Kamchatka, said on Monday, October 5, Russian Deputy Prime Minister Yuri Trutnev.

Constant emissions?

The first reports of water pollution in the Petropavlovsk-Kamchatsky area and a large number of dead animals began to arrive at the end of September.Local residents and tourists wrote about blurred vision, sore throat, nausea and other symptoms that arose after bathing and did not go away for several weeks.

At the end of September, the Kamchatka Roshydromet noted an increased content of oil products and total phenols in water samples from this area. At the same time, the message about this analysis was published on the agency’s website on October 5.

Photo author, Anna Strelchenko / TASS

Photo caption,

The authorities give different versions of what happened in Kamchatka

According to the testimony of local residents, pollution could have started even earlier.Surfer Ekaterina Dyba told the BBC that the athletes first noticed the discomfort after skiing on September 14.

“At that time it seemed that it was just poisoning with something and that’s it. But when such things began to happen to everyone who lives there, in turn, it became very strange,” she said.

Head of the Kamchatka Territorial Administration of the Hydrometeorological Service Vera Polyakova said on Monday live in the situation center of the regional government that an excess of the permissible concentration of harmful substances is constantly being recorded in Avacha Bay.

“But this is not an extreme level of pollution. We indicate this systematically in our references,” she said.

Local residents in social networks noted that by October 3, the water on Khalaktyrsky beach had become a little cleaner, but the smell of chemicals was still felt.

How not to harm yourself with the means of protection against coronavirus – Rossiyskaya Gazeta

Such “costs” of preventing the virus, alas, are not unique. Parents of schoolchildren complain that children are forced to treat their hands with an antiseptic.Some guys get red and itchy palms because of this.

“RG” has learned from experts how to use the currently popular prophylactic means in order not to harm health.

Caution, ozone

For disinfection of indoor air, it is recommended to use ultraviolet bactericidal irradiators. They are installed in enterprises, catering establishments, as well as in a number of educational institutions.

As explained in the Voronezh department of Rospotrebnadzor, such installations should be used in rooms through which a large number of people pass.But at the same time, you need to carefully read the instructions: lamps of a certain type can give excessive radiation, which is why the concentration of ozone in the air increases. And this gas with the “smell of rain” has a rather unpleasant effect on the body.

– If you were in the room where the quartz lamp worked, or did not ventilate the room after it was turned off, then a burn of the retina or skin, photodermatitis is possible, – explained dermatovenerologist Oksana Antonova.

Rospotrebnadzor added that according to the guidelines, bactericidal irradiators can be used in the presence of adults, but there should be no children or patients with pulmonary diseases in the room.It is recommended to use ozone-free lamps and thoroughly ventilate the room after UV treatment.

Expensive mistakes

At the Smolensk Ledvance plant, where consumables are produced, including for irradiators, at the request of RG, they gave advice on the choice of bactericidal lamps.

A poor-quality or incorrectly used device will turn out to be useless for fighting dangerous microorganisms and can harm human health, noted product manager Ekaterina Zhuravleva:

– Firstly, you should not choose a lamp by packaging, relying on bright images or tempting inscriptions like “Kills 99.9% of viruses and bacteria” and “100% safe”.First of all, pay attention to the technical parameters. The radiation wavelength of the germicidal lamp should be in the range of 205-315 nanometers. The longer wavelength part of the spectrum (> 315 nm), as in popular UV flashlights and lamps for disinfection in tanning salons, is useless in the fight against viruses. Secondly, on the packaging or the device itself, there must be a special marking (UVC icon), and possibly a warning text that the product is not intended for lighting.After all, we are talking about radiation, which not only destroys pathogenic microorganisms, but also poses a danger to all living things, as well as some paints, tissues and materials.

Do not rely on bright images or tempting inscriptions like “Kills 99.9% of viruses” and “100% safe”

The bactericidal efficiency of the device is measured in watts and tells how much of it will go to useful UV radiation. This indicator differs for different types of lamps; according to it, you can choose the most effective among analogs.

It is worth paying attention to the presence of accompanying documentation: operating manuals, instructions or a technical passport with a note that in front of you is a special-purpose device, bactericidal. If the product is imported, the text must be translated into Russian.

– Now that the demand for decontamination lamps has increased dramatically, they are being supplied to customers through a variety of sales channels. It would seem that what is easier: I turned to an online store, chose a cheaper product and with delivery.But not every site, especially a foreign one, offers certified products and is responsible for its quality, – Zhuravleva emphasized. “Therefore, it is safest to buy germicidal lamps and recirculating irradiators from reliable suppliers. See what kind of company released the product, how well known it is, whether there are representatives in the Russian Federation. Take a look at her website, see the assortment. It is risky to buy UV lamps for a low price only.

Strictly according to the instruction

There are several types of lamps for disinfection of premises, the most popular are quartz and ozone-free bactericidal lamps.Many consider them interchangeable: the device is similar, both contain mercury vapor, which, under the influence of an electric current, emit ultraviolet light. But when a quartz lamp is operating, part of the radiation occurs in the short-wavelength spectrum (185 nm), which converts oxygen into ozone. Hence the mentioned precautions.

Low pressure germicidal lamps are safer for everyday use. They are made from uviol glass, which allows the “useful” rays to pass through, but filters out those that lead to the formation of ozone.This means that there is no need to ventilate the room after their work.

– Often, consumers try to install a germicidal lamp in a standard fluorescent lamp housing. This is not recommended as UV radiation will destroy most polymers. Therefore, in the production of bactericidal devices, plastic parts are replaced with more resistant components or shielded, ” warned Ekaterina Zhuravleva. – There are cases when people cut off the body of the luminaire and install a UV lamp by connecting it to a ballast of inappropriate power.Even if the lamp turns on, it will not work properly and for a short time.

It is also risky to assemble a mercury arc lamp air disinfection device for street and industrial lighting systems. “Craftsmen” have posted a lot of such videos on YouTube, but in no case should this be done.

Carefully read what area your illuminator is designed for and how long it can be turned on without interruption.

– Ozone-free germicidal lamps can be used in various types of structures.Closed casing recirculators can be operated in the presence of humans, animals and plants. Open – no. But the open-type irradiator is more effective, it disinfects not only air, but also surfaces. But remember that the useful life of the germicidal lamp is limited, added Ekaterina Zhuravleva. – For replacement, buy only lamps of the power for which the device is designed. And, of course, do not forget to promptly clean the lamp surface from dust or dirt.

How to use antiseptics and masks correctly?

Oksana Antonova, dermatovenerologist at the Expert clinic (Voronezh):

– If possible, wash your hands with soap – it does not dry out the skin so much and, as a rule, does not irritate it, but is effective for preventing transmission infections.Antiseptics strongly degrease the skin and can lead to dryness, flaking, itching, and redness. Apply a protective moisturizer regularly to prevent these symptoms. If there are signs of irritation on the skin, you can use emollients or creams with panthenol, zinc – if there are no contraindications. If these remedies don’t work, see a dermatologist.

In the face mask made of natural fabrics, the skin will breathe. To avoid mechanical irritation, choose a softer material and a size that suits you.Change the mask every three hours, do not touch the wrong side with your hands. After using the mask, wash yourself with plain warm water. Don’t rub your skin, but pat dry with a towel, then apply a moisturizing emulsion or milk based on your skin type. Fatty creams under the mask should not be used. If the rash does appear, exclude skin contact with decorative cosmetics and foundation. Taking into account the fact that under the mask the sebaceous and sweat glands work in an enhanced mode, it is generally not recommended to use creams under it.In the presence of acne, the doctor may prescribe, on the contrary, drying agents.

All materials from the story “COVID-19. We can handle it!” read here .

How to reheat wax correctly and safely?

Trying to make the hair removal procedure safe and fast, the masters are very careful with the choice of waxes, but they often forget about the equipment and accessories. But a properly similar heater is the guarantor of a successful procedure.

It is possible to properly and safely warm up wax only in special equipment. Masters need professional equipment to work in beauty salons. How to choose the right heaters for waxes, what to look for.

There are two types of heaters – for warming up wax in cartridges and for warming up wax in cans. The task of any heater is to warm up the wax to the required, safe temperature.The heater must be equipped with a thermostat. This will allow the wax not to overheat, but to be in working condition for a long time. After disconnecting from the mains, the device usually continues to maintain the operating temperature of the wax for 15 minutes. Observing the rules of warming up the wax, you exclude the possibility of burns during the procedure.

Heaters for wax in cartridges (for one or more cassettes) must have:

two glowing plates for uniform heating of warm wax to operating temperature (39-40 degrees) in 20-25 minutes
indicator light
It is very convenient for masters in salons:
if heaters have a transparent window to control wax residues
base heater for simultaneous heating of several wax cartridges (two or more).

Jar warmers are intended for warming up warm wax in 400 ml or 800 ml jars, as well as hot wax and film wax.

All canned wax melters must have:

an accurate temperature scale so that degrees from 20 to 100 are prescribed
thermostats that allow you to keep the set temperature during operation.

It is very convenient for masters in salons with high traffic to have combined heaters for simultaneous heating of wax in a can and 2 cartridges.These heaters are equipped with independent thermostats and have an accurate temperature scale.

It is strongly not recommended to heat the wax in a microwave oven or in a water bath, as it is impossible to accurately determine the temperature of the liquid wax. Remember: a wax burn is much more painful than a hot water burn!

Rules for using the wax cartridge heater:

1.Place the wax cartridge in the heater.
2. Plug the power cord into the heater and into a power outlet.
3. The light comes on – the heating system is on.
4. The optimal heating time for the wax is 20-30 minutes. The heating time for the wax may vary depending on the type of wax and the ambient temperature.
5. Disconnect the power cord from the outlet and the device, only then can you start using it.

Rules for using a heater for wax in cans:

1.Plug the power cord into a power outlet. 2.Turn on the main switch, the green light comes on – the heater is on. An orange light indicates the device is heating up. 3.Place a can of wax in the bowl of the heater. The wax must not get into the bowl! 4. Set the desired temperature to warm up the wax. 5. The optimal heating time for the wax is 20-30 minutes. The heating time for the wax may vary depending on the type of wax and the ambient temperature. 6. The heater can be left on during the whole working day.

Heater care: The heater should be cleaned from wax residues with special means for cleaning the equipment from wax.

It is strictly forbidden to use chemical solvents, as well as to immerse the device partially or completely in water. In order for the equipment to serve for a long time and to have a good preservation, it is recommended to clean it after each use. Use protective cardboard rings that fit over the wax can.This will prevent wax from entering the heater bowl as well as the heater body itself.

The equipment must be kept clean and tidy at all times. Your workplace is your business card.

MEDICINE CATASTROPHY. Combustiology

MEDICINE CATASTROPH. Combustiology
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BURN SHOCK

Features of the course of burn shock in children.

Annually, about 1000 children are treated at the Republican Burn Center.The main etiological factor in children under 3 years old is hot water, flame burns in children over 5 years old.

Peculiarities of pathophysiology.

Body surface area. In children, there is a mismatch between body surface area and weight. This means that 7 kg of a child’s body weight is 1/10 of an adult’s weight of 70 kg, but at the same time, the surface of an adult’s body to the surface of a child’s body is 3: 1. In accordance with this pattern, damage to a certain part of the body surface leads to a greater loss of fluid than with the same burn area in an adult.In this regard, burn shock in children can develop with a lesion area of more than 5% -10% of the body surface area (depending on the child’s age and his adaptive capabilities). Children under 2 years of age have disproportionately thin skin; as a result, burns with a depth of 3A quickly transform into 3B.

Temperature regulation. Determined by dependence on a relatively large body surface and a mismatch between high losses and limited heat production as a result of low muscle mass.Temperature regulation in children under 6 months of age is less dependent on tremors and more on metabolic and thermal environment. In children over 6 months. muscle tremors compensate for heat loss. However, an optimal thermal environment reduces heat loss in both infants and older children, as the skin loses its thermoregulatory function.

Temperature sensitivity. Exposure to a thermal agent (44 degrees Celsius) for a few seconds may have no effect in older children and adults.Exceeding this temperature causes tissue destruction in a logarithmic progression. In adults, exposure within 30 seconds. (t = 54 C) causes superficial burns. In children, an exposure of 10 seconds is sufficient to cause destruction of the skin. Temperature exposure to 60 degrees causes burns with an exposure of 5 seconds for an adult and 1 second for a child.

Severity of the lesion. Depends on age, body surface area, burn depth. The burn area is measured according to the modified “rule of nines”: the head and neck are 18%, the lower limbs are 14%, the rest of the body is assessed as in adults.

Provision of first medical and qualified assistance.

Airway Restoring – See Inhalation Injury for general guidelines on airway restoration. Children with inhalation trauma should have a physical and x-ray examination of the lungs in the first 24 hours. At the first signs of respiratory distress syndrome or edema of the larynx, pharynx, epiglottis, the issue of tracheal intubation should be resolved.All children with inhalation trauma should be transferred to a burn center for specialized medical care.

Restoration of blood circulation. Newborns and children with burns with an area of more than 10% should be hospitalized in a burn center. Mandatory measures before transportation are: establishment of intravenous access (possibly a peripheral catheter), infusion therapy. In children with extensive burns, an intravenous catheter can be inserted through the burn surface.A urinary catheter is required for dynamic monitoring of the effectiveness of fluid therapy.

Ringer Lactate (saline) is a starting solution for children of all age groups. For unloading the gastrointestinal tract, as well as for the prevention of aspiration of gastric contents, a nasogastric tube is indicated. In newborns, hypoglycemia is possible in the first hours after injury, due to low glycogen stores. Therefore, the glycemic level should be determined every 3 hours.If there is hypoglycemia, or normoglycemia at the lower limit of the norm (3-4 mmol / l), start the infusion of 5% glucose without insulin.
The basic formula for calculating the volume of infusion therapy is the Parkland formula:
3-4 ml x Kg. x% burn within 24 hours.
This formula does not include physiological fluid. The calculation is carried out according to the following scheme:
100 ml x kg. – for the first 10 kg. weight + 50 ml x kg. for every kg. from 11-20 kg. + 20 ml x kg. for the next after 20 kg.body weight.
Thus, a child weighing 23 kg requires:
1000 ml + 500 ml + 60 ml = 1560 ml / 24 hours
This liquid can be administered enterally.

Evaluation of the adequacy of infusion therapy is carried out on the basis of hemodynamic data (heart rate, blood pressure, CVP) and hourly urine output. In children under 30 kg, it should be at least 1 ml x kg x hour. In children weighing more than 30 kg, the diuresis is 30-50 ml. x hour.

In the first 8 hours, half of the calculated volume is introduced (glucose-salt solutions in a 1: 1 ratio).In the next 8 hours, 5% glucose is replaced by 10%. In children, given the hydrophilicity of tissues, it is recommended to prescribe native colloids (FFP, albumin) at a dose of 20 ml / kg / day. already after the first 12 hours. On the following days, the treatment regimen and laboratory evaluation are the same as in adults.
Special mention should be made of young children with various constitutional anomalies (lymphatic-hypoplastic, exudative-catarrhal diathesis) and malnutrition (malnutrition, paratrophy). Among this group of children, there are often adaptation deficient children requiring special attention, for whom even a small area of the burn can become an incompatible trauma.

To assess these conditions and predict it is necessary: 

to carefully collect a life history,
to estimate the weight of the child,
examine intact skin areas (rash, scratching, gneiss, diaper rash),
carefully evaluate the reaction to trauma (skin color, temperature, marbling, acrocyanosis, etc.),
state of central hemodynamics,
general blood test (HB, HT, leukocyte formula, lymphocytes),
biochemical blood test (total protein, natremia, glycemia).

An adequate inflammatory response to trauma can be assessed by the following indicators: central hemodynamics + natremia + glycemia + lymphocytes. Hyperdynamic circulation in the background: natremia (145-150 mmol L), moderate hyperglycemia (7-8 mmol / L), reduced lymphocyte count and an increase in the total number of leukocytes due to stab neutrophils indicate the adequacy of the inflammatory response. These children require a standard treatment regimen for burn shock (see below).above).

Normodynamic or hypodynamic blood circulation against the background of natremia (130 – 135 mmol / l), a tendency to hypoglycemia, normal or increased lymphocyte count indicate the inadequacy of the inflammatory response. These children require the appointment of corticosteroids (preferably hydrocortisone) from the first hours of the disease at a dose of 4-6 mg / kg for prednisolone.

How to measure burns. Measuring Burns: A Comprehensive Guide to Determining Total Body Surface Area (TBSA)

Understanding Total Body Surface Area (TBSA) in Burn Assessment

Why is TBSA Important?

Common Methods for Estimating Burn Surface Area

1. Lund and Browder Chart

2. Wallace’s Rule of Nines

3. Palmar Method

Factors Affecting TBSA Calculation Accuracy

Tips for Accurate TBSA Measurement

The Role of TBSA in Burn Management

Fluid Resuscitation

Transfer Decisions

Ongoing Care Planning

Challenges in TBSA Estimation

Interobserver Variability

Depth Assessment

Special Populations

Emerging Technologies in Burn Assessment

3D Scanning and Imaging

Artificial Intelligence and Machine Learning

Mobile Applications

The Future of Burn Assessment and TBSA Calculation

Biomarkers for Burn Severity

Telemedicine in Burn Care

Personalized Burn Care

Burn %TBSA – Vic Burns

Tips:

Introduction | Mersey Burns for calculating fluid resuscitation volume when managing burns | Advice

Introduction

Burns Percentage Surface Area

Other methods of assessing percentage burns include the following:

Emergency and Urgent Care for Children: a Survival Guide

Assessment of Depth of Burn

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Enhancing Healthcare Team Outcomes

Calculating body surface area: Burn assessment for EMS

burn | injury | Britannica

Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form | World Journal of Emergency Surgery

METHODS FOR DETERMINING AREA BURNS

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