Rule nines burn chart. Rule of Nines Burn Chart: Essential Guide for Assessing Burn Severity in Adults and Children

11.09.202303.07.2023 by alexxlab

What is the Rule of Nines burn chart. How is it used to assess burn severity in adults. Why is the Rule of Nines modified for children. What are the key differences in burn assessment between adults and children. How does the Rule of Nines help determine treatment needs for burn victims.

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Understanding the Rule of Nines: A Vital Tool in Burn Assessment

The Rule of Nines is a crucial method used by medical professionals to quickly assess the severity of burns in patients. This technique allows for rapid calculation of the total body surface area (TBSA) affected by burns, which is essential for determining appropriate treatment strategies.

But what exactly is the Rule of Nines, and how does it work? The Rule of Nines assigns percentage values to different body parts, with each section representing either 9% or a multiple of 9% of the total body surface area. This simple yet effective system enables healthcare providers to make swift, accurate estimations of burn severity.

Origin and Development of the Rule of Nines

The Rule of Nines is sometimes referred to as the Wallace Rule of Nines, named after Dr. Alexander Wallace, the surgeon who first published this method. However, the original creation of this technique is credited to Pulaski and Tennison. Their work laid the foundation for this invaluable tool in burn assessment and treatment.

Applying the Rule of Nines in Adult Burn Assessment

For adults, the Rule of Nines provides a straightforward breakdown of body surface area percentages:

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)
Groin: 1%

This breakdown allows medical professionals to quickly sum up the affected areas and determine the total percentage of body surface area affected by burns.

When is the Rule of Nines Used?

The Rule of Nines is primarily employed for assessing:

Second-degree burns (partial-thickness burns)
Third-degree burns (full-thickness burns)

It’s important to note that this method is not typically used for minor first-degree burns, as these generally do not require the same level of intensive treatment and fluid resuscitation as more severe burns.

Clinical Applications of the Rule of Nines

How do medical providers utilize the information gathered from the Rule of Nines? The percentage of TBSA affected by burns plays a crucial role in several aspects of patient care:

Fluid Resuscitation

One of the primary applications of the Rule of Nines is determining the need for and amount of fluid replacement. When a person suffers second-degree burns or worse, the protective layer of skin is compromised, leading to significant fluid loss. The National Institutes of Health states that burns covering more than 20-25% of TBSA require substantial intravenous (IV) fluid administration. The estimated burn surface area directly informs the volume of fluids to be administered.

Determining Level of Care

The Rule of Nines also helps medical teams assess the overall severity of burns and determine the appropriate level of care. For instance:

Burns covering 30% or more of TBSA can be potentially fatal
Burns affecting 10% or more of TBSA typically require treatment at a specialized burn center

IV Access Requirements

The extent of burns also dictates the need for intravenous access:

Burns covering 15% or more of TBSA require at least one peripheral IV line
Burns affecting 40% or more of TBSA necessitate at least two IV lines

Modifications of the Rule of Nines for Pediatric Patients

While the Rule of Nines is highly effective for adult burn assessment, it requires modification when applied to children. Why is this adjustment necessary? Children have different body proportions compared to adults, which affects the percentage calculations for various body parts.

Key Differences in Pediatric Body Proportions

Some notable differences in children’s body proportions include:

Larger heads: Children’s heads are proportionally about 20% larger than adults’
Smaller legs: Infants have approximately 13% smaller legs compared to adults

Adjusted Rule of Nines for Children

To account for these differences, the Rule of Nines is modified for pediatric patients:

Head and neck: 18% (double that of adults)
Each arm: 9% (same as adults)
Chest and abdomen: 18% (combined)
Back: 18% (combined upper and lower back)
Each leg: 14% (28% total for both legs, reduced from adults)
Genitalia: 1% (same as adults)

These adjustments ensure more accurate burn assessment in pediatric patients, leading to more appropriate treatment decisions.

Limitations and Considerations of the Rule of Nines

While the Rule of Nines is an invaluable tool in emergency burn assessment, it’s important to recognize its limitations and considerations for use:

Accuracy in Various Body Types

The Rule of Nines assumes a standard body type and may be less accurate for individuals with significantly different body proportions, such as those who are obese or very muscular. In these cases, medical professionals may need to make additional adjustments to their assessments.

Combination with Other Assessment Methods

In clinical settings, the Rule of Nines is often used in conjunction with other assessment tools and techniques. For more precise measurements, especially in less emergent situations, healthcare providers may use methods like the Lund and Browder chart, which provides a more detailed breakdown of body surface areas.

Ongoing Reassessment

It’s crucial to note that burn assessment is not a one-time event. As burns evolve over time, ongoing reassessment is necessary to ensure appropriate treatment adjustments.

Importance of Specialized Care for Severe Burns

The Rule of Nines helps identify cases that require specialized burn care. When should a burn victim be treated at a specialized burn center? Consider the following criteria:

Burns covering 10% or more of TBSA
Burns involving critical areas such as hands, feet, genitalia, face, or major joints
Chemical burns
Electrical burns
Presence of third-degree burns
Pediatric burn cases

Specialized burn centers have the expertise, equipment, and resources to provide optimal care for severe burn cases, potentially improving outcomes and reducing complications.

The Role of the Rule of Nines in Emergency Response

How does the Rule of Nines impact emergency response to burn injuries? This method plays a crucial role in the initial assessment and triage of burn victims:

Rapid Assessment

The simplicity of the Rule of Nines allows for quick estimation of burn severity, even in chaotic emergency situations. This rapid assessment is vital for making immediate treatment decisions and determining the need for specialized care or transfer to a burn unit.

Communication Tool

The Rule of Nines provides a standardized way to communicate the extent of burns between different healthcare providers and facilities. This common language ensures that all involved parties have a clear understanding of the patient’s condition.

Resource Allocation

In mass casualty incidents involving burns, the Rule of Nines can help emergency responders quickly prioritize patients based on the severity of their injuries, ensuring that those with the most critical needs receive attention first.

The Rule of Nines stands as a testament to the power of simple, effective tools in emergency medicine. By providing a quick and reliable method for assessing burn severity, it enables healthcare providers to make rapid, informed decisions that can significantly impact patient outcomes. While it has limitations and requires modifications for different patient groups, its continued use in burn assessment underscores its enduring value in clinical practice.

As our understanding of burn injuries and treatment continues to evolve, the Rule of Nines remains a fundamental component of burn care, bridging the gap between initial assessment and comprehensive treatment. Its simplicity and effectiveness make it an indispensable tool for healthcare providers dealing with burn injuries, ultimately contributing to better patient care and improved outcomes in burn management.

Burns, Children, Adults, Wallace, and More

Rule of Nines: Burns, Children, Adults, Wallace, and More

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Medically reviewed by Alana Biggers, M. D., MPH — By Rachel Nall, MSN, CRNA — Updated on July 20, 2018

What is the rule of nines?

The rule of nines is a method doctors and emergency medical providers use to easily calculate the treatment needs for a person who’s been burned.

It’s sometimes referred to as the Wallace rule of nines after Dr. Alexander Wallace, the surgeon who first published the method. The creation of this method is credited to Pulaski and Tennison.

A medical professional will do a visual examination to look for seriously burned areas and use the rule of nines to quickly add up what percentage of a person’s body is burned. While doctors will perform more thorough examinations for burn estimation, they can use the rule of nines to quickly assess a person and start recommending treatment centers and interventions to help a person.

The rule of nines is meant to be used for:

second-degree burns, also known as partial-thickness burns
third-degree burns, known as full-thickness burns

The rule of nines assigns a percentage that’s either nine or a multiple of nine to determine how much body surface area is damaged. For adults, the rule of nines is:

A medical provider can use calculations from the rule of nines in several ways. This includes the amount of fluid replacement and degree of care a person needs.

When a person experiences a second-degree burn or worse, the protective layer of skin is destroyed. As a result, they’ll lose a significant amount of body water. This makes providing fluids vital to helping a person maintain their total body water. According to the National Institutes of Health, burns that are greater than 20 to 25 percent of total body surface area require significant intravenous (IV) fluids. Doctors will also use the estimated body surface area burned to determine how much fluid to administer.

The rule of nines can also relay to a medical team receiving the patient how serious the injury is. Providers also know that burns that exceed 30 percent of a person’s body can be potentially fatal, according to the National Institutes of Health.

If a person has burns on 10 percent of their body surface area or greater, a specialized burn center should treat their wounds. Other circumstances where a burn center should treat the wounds include:

when the person is a child
when the burned areas involve key areas of the body, such as the hands, feet, genitalia, face, or major joints
chemical burns
electrical burns
the presence of third-degree burns

Another example of how a provider may use the rule of nines is to determine how much IV access is needed. If a person has 15 percent or more of their total body surface area burned, they’ll need at least one peripheral line to provide IV fluids. If a person’s body is burned 40 percent or more, they’ll need at least two IVs.

Doctors don’t typically use the same calculations in the rule of nines to children. This is because children tend to have different body proportions than adults do, including larger heads and smaller legs. For example, children tend to proportionally have a 20 percent larger head than adults, according to the National Institutes of Health. Infants also have 13 percent smaller legs than adults.

Therefore, there are a few adjustments for the rule of nines in children:

Burns are a serious, painful injury that require immediate treatment and intervention. The rule of nines serves as a quick method of assessment for a medical provider to estimate the extent of a person’s injuries. If the person with burns is a child, the rule of nines should be adjusted due to differences in a child’s proportions.

Last medically reviewed on July 19, 2018

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Assessing burns and planning resuscitation: The rule of nines. (n.d.).
uwhealth.org/emergency-room/assessing-burns-and-planning-resuscitation-the-rule-of-nines/12698
Burn triage and treatment – Thermal injuries. (2017).
chemm.nlm.nih.gov/burns.htm
Helttiaratchy S. (2004). Initial management of a major burn: II—assessment and resuscitation. DOI:
10.1136/bmj.329.7457.101
Lee KC, et al. (2014). History of burns: The past, present and the future. DOI:
10.4103/2321-3868.143620
Quick reference guide: Burn stabilization. (n.d.).
uwmedicine.org/airlift-nw/Documents/burn-pocket-card-final.pdf

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Medically reviewed by Alana Biggers, M.D., MPH — By Rachel Nall, MSN, CRNA — Updated on July 20, 2018

Rule of Nines for Burns in an Adult NCLEX Review

This NCLEX review will discuss the Rule of Nines for burns in an adult patient.

If you’re studying burns right now in class, you can probably count on a rule of nines burn question being on your exam. It’s a popular topic to cover on a burns exam.

Lecture on Rule of Nines

What is the Rule of Nines?

It’s a quick calculation that can be used to calculate the total body surface area (TBSA) percentage that is burned on a patient. It is used for burns that are at least partial-thickness or greater.

Why do we need to know the total body surface area percentage burned on a patient?

It tells us the severity of the burn. For example, does this patient need specialized care and meet the criteria for a burn unit? Another reason, which is a BIG one, this percentage will determine the fluid replacement treatment regime.

When a patient experiences about 15% or more of a total body surface area that is burned there is a major change in capillary permeability and the patient most definitely needs fluid replacement (Diver, 2008).

What happens during a severe burn to the capillary permeability?

When a patient experiences a major burn, there is a shift of fluid from the intravascular area to the interstitial tissues (so fluid leaves the blood), and this is due to an increase in capillary permeability. Because of this shift there will be barely anything left in the circulation for the heart to pump to vital organs…without blood they start to die. So, a patient is at risk for hypovolemic shock when they experience severe burns.

Lactated Ringer’s (an isotonic solution) is most commonly used to help expand the intravascular compartment. To determine how much fluid a patient will need 24 hours after a severe burn, the Parkland Burn Formula is used (please see the next review for how to calculate the amount of fluid a patient needs after a severe burn).

Rule of Nines for Burns

Now, let’s look at the Rule of Nines!

Each area of the body is broken down by nines (hence makes it easier to remember). I like to start my way from the top and work downward:

NOTE: Remember that there is a FRONT AND BACK percentage value assigned to EACH AREA (many people forget this and get their calculation wrong).

Adult:

Head and Neck: 9% (4.5% anterior and posterior)

Right Arm: 9% (4.5% anterior and posterior)

Left Arm: 9% (4.5% anterior and posterior)

Trunk: 36% (18% anterior and posterior)

Perineum: 1%

Right Leg: 18% (9% anterior and posterior)

Left Leg: 18% (9% anterior and posterior)

Total: 100%

Rule of Nines Practice Problem:

A 35 year old female patient has deep partial-thickness burns on the front and back of both arms, anterior trunk, back of left leg, anterior and posterior sides of the right leg, posterior head and neck, and perineum. What is the total body surface area percentage that is burned?

FRONT and BACK of both arms: 18%

ANTERIOR trunk: 18%

BACK of left leg: 9%

ANTERIOR and POSTERIOR of right leg: 18%

POSTERIOR head and neck: 4.5%

Perineum: 1%

Total: 68.5%

Algorithm of action in case of burns – News

Burns are one of the most common fire injuries. Therefore, it is important for all of us to know the techniques and methods of providing first aid to victims of burns.

The tragic consequences of burns would have been much less if help had been provided correctly from the first minutes. It is enough to apply a scheme of actions available to everyone directly at the scene of the incident in order not only to reduce pain, but also to significantly increase the likelihood of saving the victim.

As a rule, burns received in a fire are thermal, that is, obtained from direct exposure to fire, hot metal objects, flashed combustible liquid. By the way, thermal burns also include injuries received from boiling water or hot water.

It is important to be able to distinguish between degrees of burns. There are 4 degrees of burns:

I degree – skin redness, swelling. The mildest degree of burn.

II degree – the appearance of blisters filled with a clear liquid (blood plasma).

III degree – necrosis of all layers of the skin. Proteins of skin cells and blood coagulate and form a dense scab, under which there are damaged and dead tissues.

IV degree – charring of tissues. This is the most severe form of a burn, in which the skin, muscles, tendons, and bones are damaged.

The first factor influencing the severity of the victim’s condition is the area of the burn. You can determine the area of the burn using the “rule of nines”: the skin surface of the palm is 1% of the body surface, the skin surface of the hand is 9%, the skin surface of the leg – 18%, the skin surface of the chest in front and behind – 9% each, the skin surface of the abdomen and lower back of the abdomen and lower back – 9% each. Burn of the perineum and genitals – 10% of the burn area. Burns in these areas are shock injuries. There are superficial and deep burns; limited (less than 10%) and extensive (more than 10%).

REMEMBER! With large burns, life-threatening dehydration occurs.

BURN SCHEDULE:

1. Stop exposure to high temperature on the victim, extinguish the flame on his clothes, remove the victim from the affected area.

2. Specify the nature of the burn (flame, hot water, chemicals, etc.), as well as area and depth. Wrap the victim in a clean sheet and immediately deliver to a medical facility.
3. Carry out transport immobilization, in which the burned areas of the body should be in the most stretched position.

4. With a small burn, the burnt area can be placed under a stream of cold water from a tap for 10-15 minutes, with extensive burns this should not be done.

5. It is better to cut the clothes in the places of the burn and apply an aseptic bandage around the burn, while cotton should not be applied.

6. When transporting the wounded to a medical institution, ensure that he is calm.

IT IS FORBIDDEN:
– to leave the victim alone;

– apply ointment, cream, vegetable oil to the burned area, sprinkle with powders;

– pierce bubbles;

– remove clothing from the burned area;

– in case of a burn of the oral cavity, give food and drink.

The Main Directorate of the Ministry of Emergency Situations of Russia for the Kabardino-Balkarian Republic reminds:

If you are in an emergency and you need the help of firefighters or rescuers – a single number to call all emergency services from the mobile phone “112” and “01” from the stationary.

Determination of burn area: rule of nines and palm

Table of contents

Degrees
Symptoms
Determining the area
Rule of the hundred
Rule of nines
Rule of the palm

9 0059 Postinkov method

Dolinin method
Conclusion

Last Updated on 06/23/2017 by Perelomanet

A burn is an injury to the soft tissues of the human body that occurs as a result of negative thermal, electrical or chemical effects. For the correct provision of first aid and the choice of the method of subsequent treatment, it is necessary to determine the severity of the injury and the area affected by it. There are many techniques that allow you to accurately subtract the area of burns.

The area of the human body is approximately 21,000 square centimeters. Scientists have invented many schemes and formulas that help calculate the burn area in children and adults. If you correctly calculate the size of the injured area, then you can determine the severity of the injury that has arisen.

Degrees

There are several degrees of severity of this injury:

first degree burn – slight swelling and redness form on the skin;
the second degree is accompanied by the formation of minor blisters with a special internal fluid that protects the wound of infection. With a burn of this type, the skin begins to exfoliate and pain is present;
third degree type A – characterized by a fairly deep damage to the skin, the formation of a brown crust and pain;
third degree type B – with a burn of this type, complete death of the skin occurs;
4th degree burns are the most serious damage to the skin, affecting blood vessels, muscles, joints, and sometimes even bones. Pain is not observed due to complete charring of the skin.

First, second, and third A degrees are called superficial burns, while degrees 3B and fourth, respectively, are called deep. Superficial injuries are always associated with pain, but deep ones are not. The absence of pain in this case is explained by the complete necrosis of the affected epidermis.

Symptoms

Signs of a burn depend on the type of burn surface and the nature of the injury, but there are a number of main symptoms that most often appear with such an injury:

change in skin color from reddish to black. The color depends on the nature and severity of the damage;
the appearance of blisters (see burn blister: what to do), which are filled with a special liquid;
the formation of a dryish crust in the injured area;
severe pain;
death of the skin;
charring of the skin.

Determining the area

Injury treatment is prescribed only after an accurate determination of the nature of the injury, in order to determine the depth of the injury and its severity – the area of the burn should be subtracted.

Hundreds rule

The simplest way to calculate the injured surface in adults is the “hundred rule”. In the event that, adding up the age of the victim and the total area of \u200b\u200bthe injury, a number close to a hundred comes out, then the lesion is considered unfavorable, and it requires special treatment.

The Rule of Nines

In 1951, scientist A. Wallace invented a computational method called the Rule of Nines for Burns. This type of calculation of the wounded surface is quite fast and easy. The data obtained as a result of the calculation is inaccurate, but quite approximate.

This method consists in dividing the human body into separate zones. Each such plot in relation to the percentage is equal to nine. Neck and head – 9%, each individual limb – 9%, the torso front and back results in 36%, and 1% is allocated to the genital area.

This method is not suitable for determining burns in children, because the proportions of their bodies are slightly different.

Rule of the palm

In 1953, I. Glumov invented an even simpler method for calculating the injured surface. According to the rule of the palm, the burn zone is equal to the palm of the victim. Its size is approximately considered one percent of the entire surface of the human body. This method is used as often as the “rule of nine”.

Postinkov’s method

Postnikov’s method is a rather old determination of the burn area and is not easy. It is based on the application of a gauze bandage to the wounded surface, and a contour drawing of the injury is applied on top of it. After that, the resulting shape is superimposed on graph paper and a general calculation of the surface is carried out in relation to the damaged skin. Due to the difficulties that arise during such a calculation, it is practically not used.

Dolinin method

In 1983 the Dolinin method was invented. It consists in dividing by 100 a special stamp of rubber material, which contains the silhouette of the back and front of the human body.