Rule of 7 in burns: Determining Total Body Surface Area

11.09.202329.06.2023 by alexxlab

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Understanding the Rule of Nines in Under 7 Minutes

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posted on October 11, 2014

To measure a burn in an adult, you use the rule of nines. But first, what is a burn?

Burns damage the skin or tissues of the body. Burns can be caused by chemicals, electricity, fire, liquids that are hot, or even the sun.

Now there is a plant that have been recently discovered in Virginia (and other locations) that can cause blindness and third-degree burns. This is the giant hogweed plant. If you see a plant you are not familiar with, it’s important to not touch it.

Some burns are more severe than others. Burns can be classified by first-degree burn, second-degree burn, third-degree burn, or fourth degree burn.

First-degree burn:

Affects the epidermis (outer skin layer)
Burn site is red, painful, and dry
No long-term damage to the tissue

Second-degree burn:

Affects the epidermis
Part of the dermis layer is also affected
Burn site is red, blistered, swollen, and painful

Third-degree burn:

Affects the epidermis and dermis layer
Subcutaneous layer may be affected
Burn site is white or charred

Fourth-degree burns:

Damage to the bones, muscles, and tendons
Nerves are destroyed along with sensation to the area

NCLEX Burns Tips

Risk for hypovolemic shock with severe burns
Fluid replacement is needed with severe burns
Lactated Ringer’s is most commonly used IV fluid therapy, which is an isotonic solution.
Rule of nines is a formula used to calculate the percentage of the adult body that has been burned.

What is the rule of nines?

The rule of nines uses the total body surface area (TBSA) that has been burned to estimate the percentage of the adult body that has received the burn. Using the rule of nines help us determine how severe the burns are on the adult body.

Knowing how to use the rule of nines to calculate properly is critical for the nursing management to help decide how to treat burn victims.

How do you use the rule of nines to measure a burn?

Each body part is measured as 9% of the body.

Head – 9% of the total body surface area
Anterior torso – 18% of the total body surface area
Posterior torso – 18% of the total body surface area
Each arm – 9% of the total body surface area
Genitalia – 1% of the total body surface area
Each leg – 18% of the total body surface area

Rule of Nines Calculation NCLEX Tips:

Front of head is 4. 5% and back of head is 4.5%. If only the front of the head has been burned, you do not calculate it as 9%. You only calculate 4.5%.
The entire torso is 36% of the body.
Both arms are 18% of the total body surface area. Each arm is 9%. If only the front of the arm is burned, then that is 4.5%. If only the back of the arm is burned, that is 4.5%.
Both legs is 36% of the total body surface area. If only the front of the leg is burned, then it is 9% of the total body surface area. If only the back of the leg is burned, it is 9% of the total body surface area. If the entire leg is burned, it is 18% of the total body surface area.

Use your new knowledge and measure a burn using the rule of nines now!

Rule of nines calculation: The front of the head and the right arm

Front of the head – 4.5%
Right arm – 9%

Total body surface area affected by burns = 13.5%

Rule of nines calculation: Torso, head, and both arms

Torso – 36%
Head – 9%
Both arms – 18%

Total body surface area affected by burns = 63%

Rule of nines calculation: Front right leg, genitalia, right arm

Front of the right leg – 9%
Genitalia – 1%
Right arm – 9%

Total body surface area affected by burns = 19%

Rule of nines calculation: Chest, front of the right arm, front of head, gentalia, and right leg

Chest – 18%
Front of the right arm – 4. 5%
Front of the head – 4.5%
Gentalia – 1%
Right leg – 18%

Total body surface area affected by burns = 46%

HT: Emergency Medical Counsel

Filed Under: Adult Care, Integumentary

7 burns

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Editor’s Notes

Burns What are burns? What causes burns? How are burns classified? How to treat a patient with burns? What are the complications of burns?
Definition of burns It is an injury or damage caused by heat or sources producing heat leading to coagulation necrosis. Damage rarely occurs when temperature is below 45°C.
Coagulation necrosis Coagulation necrosis is a type of cell death caused by ischemia or infarction. In coagulative necrosis, the architecture of dead tissue is preserved for at least a couple of days. The injury denatures lysosomal enzymes thus blocking the proteolysis of the damaged cells. The lack of lysosomal enzymes allows it to maintain a “coagulated” morphology for some time. Like most types of necrosis, if enough viable cells are present around the affected area regeneration will usually occur.
Various causes of burns are:1. Dry heat: Fire 2. Wet heat: Hot liquids e.g. boiling water, tea, coffee etc. The injury is known as scald. These are usually minor burns.3. Electric burns: Electric current 4. Chemical burns: Acids or alkali. It causes progressive damage because the agent remains in contact with the skin and chemical injury continues. 5. Irradiation: Radiotherapy given for cancer treatment.
Scald of the chest caused by boiling water
The skin consists of superficial layer (epidermis) and deep layer (dermis). There are appendages in skin like hair follicles, sweat and sebaceous glands. These lie in the dermis but project in epidermis as well. Burns are divided into three degrees based on thickness of involved skin 1° burn: It is a burn involving epidermis only e.g. sunburn.2° burn: It is a burn involving epidermis and part of dermis e.g. scalds 3° burn: It is a burn involving epidermis and full thickness of dermis e.g. flame, chemical and electric burns. 4o burn: It is a burn involving whole of skin as well as muscles and bones
1° burn: There is painful erythema of skin. It is tender to touch and blanches on pressure. It is of little clinical significance because water barrier of skin is not disturbed. Hence, it is not considered while estimating magnitude of burn injury and planning fluid replacement. 2° burn: It usually presents with painful blisters. When blisters rupture, the surface of burn appears red, shiny and wet (angry looking) 4° burn: It is painless because all cutaneous nerves are burnt. The burn surface appears dry, charred, grayish black in color.
1° burn: There is painful erythema of skin. It is tender to touch and blanches on pressure. It is of little clinical significance because water barrier of skin is not disturbed. Hence, it is not considered while estimating magnitude of burn injury and planning fluid replacement. 2° burn: It usually presents with painful blisters. When blisters rupture, the surface of burn appears red, shiny and wet 3° burn: It is painless because all cutaneous nerves are burnt. The burn surface appears dry, charred, grayish black in color.
1° burn: There is painful erythema of skin. It is tender to touch and blanches on pressure. It is of little clinical significance because water barrier of skin is not disturbed. Hence, it is not considered while estimating magnitude of burn injury and planning fluid replacement. 2° burn: It usually presents with painful blisters. When blisters rupture, the surface of burn appears red, shiny and wet 3° burn: It is painless because all cutaneous nerves are burnt. The burn surface appears dry, charred, grayish black in color.
4o degree burns
Treatment of Burns Pre-hospital care Hospital care
Treatment of Burns Pre-hospital care
Pre-hospital care The principles of pre-hospital care are: Ensure rescuer safety. This is particularly important in house fires and in electrical and chemical injuries. Stop the burning process. Stop, drop and roll is a good method of extinguishing fire burning on a person. Check for other injuries. A standard ABC (airway, breathing, circulation) check followed by a rapid secondary survey will ensure that no other significant injuries are missed. Patients burned in explosions or even escaping from fires may have head or spine injuries and other life-threatening problems. Cool the burn wound. This provides analgesia and slows the delayed microvascular damage that can occur after a burn injury. Cooling should occur for a minimum of 10 minutes and is effective up to 1 hour after the burn injury. It is a particularly important first aid step in partial-thickness burns, especially scalds. In temperate climates, cooling should be at about 15°C, and hypothermia must be avoided. Give oxygen. Anyone involved in a fire in an enclosed space should receive oxygen, especially if there is an altered consciousness level. Elevate. Sitting a patient up with a burned airway may prove life-saving in the event of a delay in transfer to hospital care. Elevation of burned limbs will reduce swelling and discomfort.
Stop, drop and roll is a three step procedure that a fire victim should follow to minimize injury in the event their clothing catches fire. Procedure: Stop, drop and roll consists of three steps. Stop – The fire victim must stop, ceasing any movement which may fan the flames or hamper those attempting to put the fire out. Drop – The fire victim must drop to the ground, face down if possible, covering the face with their hands to avoid facial injury. Roll – The fire victim must roll on the ground in an effort to extinguish the fire by depriving it of oxygen. If the victim is on a rug or one is nearby, they can roll the rug around themselves to further extinguish the flame.
Pre-hospital care The principles of pre-hospital care are: Ensure rescuer safety. This is particularly important in house fires and in the case of electrical and chemical injuries. Stop the burning process. Stop, drop and roll is a good method of extinguishing fire burning on a person. Check for other injuries. A standard ABC(airway, breathing, circulation) check followed by a rapid secondary survey will ensure that no other significant injuries are missed. Patients burned in explosions or even escaping from fires may have head or spine injuries and other life-threatening problems. Cool the burn wound. This provides analgesia and slows the delayed microvascular damage that can occur after a burn injury. Cooling should occur for a minimum of 10 minutes and is effective up to 1 hour after the burn injury. It is a particularly important first aid step in partial-thickness burns, especially scalds. In temperate climates, cooling should be at about 15°C, and hypothermia must be avoided. Give oxygen. Anyone involved in a fire in an enclosed space should receive oxygen, especially if there is an altered consciousness level. Elevate. Sitting a patient up with a burned airway may prove life-saving in the event of a delay in transfer to hospital care. Elevation of burned limbs will reduce swelling and discomfort.
Treatment of Burns Hospital care
In hospital check airway, breathing and circulation (ABC)
HOSPITAL CARE OF BURNS Airway Heat causes damage to upper airway (oral cavity, nasopharynx, larynx). History of fire in closed space or burns involving the mouth, lips and neck result in soft tissue swelling of the airways within hours of injury resulting in sudden airway obstruction. Therefore signs of airway obstruction (cyanoses, stridor, tachypnea) should be looked for. In case of airway obstruction, endotracheal intubation or tracheostomy may be required.
HOSPITAL CARE OF BURNS b. Breathing Toxic chemicals like carbon monoxide present in smoke cause damage to lower bronchial tree and lung parenchyma. Patient presents with hoarseness, stridor, wheezing and production of large amount of carbonaceous sputum. There is tachycardia, cyanosis and bronchospasm. Patient requires humidified oxygen, bronchodilators, steroids and artificial ventilation.
HOSPITAL CARE OF BURNS c. Circulation The patient needs rapid intravenous fluid replacement to compensate for the fluid lost from burn surface area.
HOSPITAL CARE OF BURNS c. Circulation Maintain IV line with two large bore cannula. Since peripheral veins are usually not visible due to limb burns, venesection (cut down) is done in the arm or leg to start intravenous fluids.
HOSPITAL CARE OF BURNS c. Circulation Requirement of intravenous fluid replacement is calculated from percentage area of burns.
Percentage area of burns It is calculated by Wallace rule of nine: The body is divided into eleven parts and each part covers 9%, making it 11 × 9 = 99%. The remaining 1% is the perineum
Fluid calculation is done using Parkland formula. 4 cc per percent burn/kg body weight of Ringer lactate is given in first 24 hrs. Half of the calculated fluid is given in first 8 hrs. 1/4th fluid is given in second 8 hrs. 1/4th fluid is given in third 8 hrs. Time for giving I/V fluids commences at the time of injury and not at admission to hospital.
Smoke inhalation syndrome Hypovolemic shock Septic shock Neurogenic shock Renal failure Electrolyte imbalance Curling’s ulcers—hematemesis Gastric ulcer—perforation peritonitis Suppurative thrombophlebitis (at site of I/V lines) Malnutrition (protein loss) Hypertrophic scars/ contractures Marjolin’s ulcer Suppurative chondritis (thermal injury to ear cartilage)
Smoke inhalation syndrome Hypovolemic shock Septic shock Neurogenic shock Renal failure Electrolyte imbalance Curling’s ulcers—hematemesis Gastric ulcer—perforation peritonitis Suppurative thrombophlebitis (at site of I/V lines) Malnutrition (protein loss) Hypertrophic scars/ contractures Marjolin’s ulcer Suppurative chondritis (thermal injury to ear cartilage)

First aid for burns

Dermatologist Natalia Sirmais prepared an article about what first aid should be for a burn. Everyone should know these tips.

Burns are one of the most common injuries sustained in the home. Burns can be from:

1. Temperature effects

2. Irradiation

3. Electricity

4. Chemicals

At home, the cause of a burn is usually: boiling water, an unsuccessfully left kettle, a plate of hot soup, which children’s hands have reached.

Of course, it is better not to allow such a development of events, but ridiculous accidents can happen to anyone. Shouting about “why didn’t you follow” and “how could this happen” will not help the cause. It is better to always be fully prepared and know the algorithm of action if an unpleasant situation does occur.

It is important not to panic and take action immediately. The speed with which assistance will be provided depends on the depth and area of the lesion, and later on the recovery time.

Burns are divided into 4 degrees, but the 4th degree of damage from boiling water is very rare.

With lesions of the 1st degree, only the upper layers of the skin are disturbed, accompanied by redness and slight swelling.
2nd degree is characterized by the appearance of blisters filled with a cloudy liquid. Severe pain often occurs. If you provide first aid in a timely and correct manner, then scars and other skin changes can be avoided.
Grade 3 injuries show red sores, dead tissue appears as gray or dark scabs, and both skin and muscle tissue are affected. The blisters are filled with blood or cloudy contents, the person experiences severe pain, shock may develop. In this situation, hospital treatment is required.
4th degree is accompanied by deep lesions of the skin, muscle tissue and even bones (even with their charring). This is an extremely difficult condition. Immediate hospitalization is required.

What to do is prohibited:

1. Immediately after a burn, smear the skin with oils, fats and ointments. A greenhouse effect may occur: excess heat will not be able to leave the skin, while increasing the affected area, up to tissue infection.

2. Treat with solutions containing alcohol. This will increase the pain and lead to the death of some of the damaged cells.

3. Cool the burn with ice. This will provoke frostbite and tissue death, rather than cooling.

4. Puncture blisters. In this way, an infection can be introduced into the wound. Small blisters do not require piercing, as they contain a sterile liquid that does not allow infection to enter the wound.

5. Sprinkle with flour / starch, apply grated potatoes, compresses with urine, smear with kefir / sour cream, use toothpaste or raw eggs. Such methods will not help with a burn, but they can easily harm.

6. Trying to tear off clothes or other materials that are stuck to the skin – this can lead to skin removal as well.

In what cases is an ambulance / visit to the doctor required:

1. If a child or an elderly person is injured, and the burn area is larger than the palm of an adult.

2. If the damage is deep, burns of 3-4 degrees, regardless of the area.

3. If large bubbles appear.

4. With burns of the face, eyes, perineum.

5. When signs of tissue infection appear

6. In the absence of skills and strength, provide assistance with these injuries.

So, let’s move on to the stages of first aid:

1. Take off your clothes. Don’t waste time tearing or cutting the fabric. If it sticks to the skin, do not try to peel it off. Avoid bubbles if there are any.

2. Place the affected area under moderate pressure of cold tap water. If possible, fill the container if the foot or hand is affected. This will help reduce pain and relieve swelling, cool damaged lesions and tissues around the lesion.

In case of severe damage to the skin, if it peels off, it is necessary to cool through a wet cloth, so pain from direct contact with water will decrease.

Cool the skin for 10-15 minutes.

Please note that this is the most important point of help! This method, despite its simplicity, can reduce the depth of the lesion by an entire degree (from the second degree to the first).

3. Starting from the second stage, it is necessary to give painkillers.

4. For a minor burn, after 15 minutes, blot the damaged area with a lint-free tissue, then apply a sterile non-woven dressing or cover the burn with a clean cotton cloth if nothing else is available (should not press and rub, especially if there are blisters).

For 1st degree burns, a bandage may not be needed, then apply aerosol foams (olazol / panthenol) more often, but first cool the damaged area with high quality.

5. If indicated, consult a doctor. Remember that qualified and timely provision of medical care contributes to a significant improvement in the condition of the victim, reduces / prevents the risks of infections, and also accelerates the further recovery of the body.

First aid for burns in children, what can and cannot be done

03/21/2023 03/21/2023 health

Burns are among the most dangerous types of childhood injuries. Children’s skin is thinner, more delicate and vulnerable, so burns in a child are always more difficult than in an adult in identical conditions.

Types of burns

There are several types of burns, depending on the source:

Thermal burns – those that occur when exposed to high temperatures. In most cases, children are exposed to thermal burns. Injury can be caused by: hot liquids, open flames, steam, hot water pipes and any hot objects (iron, stove, etc.)
Chemical – resulting from contact with the skin of solutions of acids or alkalis that are part of many household chemicals
Electrical – resulting from electrical injury
Radiation – arising from exposure to radiation or ultraviolet rays

According to the depth of the skin lesion, 3 degrees of thermal burns are distinguished:

I – only the upper layer of the skin (epidermis) is affected. Characterized by slight pain and redness
II – the entire epidermis is affected. Fluid-filled blisters appear that cannot be opened on your own
III – necrosis of all layers of the skin, reaching the subcutaneous fat
IV – necrosis affects all tissues, including bone and muscle

What to do if your child is burned

It is very important to give your child first aid correctly and not damage the damaged skin further. The rules for first aid are slightly different, depending on the type of burn.

For thermal burns:

Isolate the child from the source of heat, carefully remove clothing and accessories from the affected area
Cool affected area under cool (not icy) running water for 10 to 15 minutes
Cover the burned area with a clean, smooth, lint-free cloth
Use hydrogel pads as a great alternative to cold compresses
Pain relievers such as Ibuprofen can be given to relieve pain.
For moderate to severe burns or extensive burns, call an ambulance
Try to keep the burn area elevated until help arrives

In the event of a chemical burn, wash the injured skin with plenty of cool running water and apply a dry, sterile dressing. If you are not sure about the composition of the remedy, it is better to seek medical help.

In the event of an electrical injury, first turn off the power source before touching the child. Wrap your hands in a cloth or use gloves to prevent yourself from being exposed to current. If the child is conscious, cool the burn area with running water and cover with a bandage. Call an ambulance immediately.

For sunburn, cool compresses and non-alcohol moisturizers are recommended. If, in addition to the burn, the child also received sunstroke, it is necessary to visit a doctor.

What not to do with burns

Damaged tissues must be protected from additional trauma. Therefore, for any burns, you should follow the rules:

Do not apply oils, fatty creams and ointments, sour cream, kefir, soda and other powders to the burn area.

Rule of 7 in burns: Determining Total Body Surface Area

Understanding the Rule of Nines in Under 7 Minutes

To measure a burn in an adult, you use the rule of nines. But first, what is a burn?

NCLEX Burns Tips

What is the rule of nines?

How do you use the rule of nines to measure a burn?

Rule of Nines Calculation NCLEX Tips:

Use your new knowledge and measure a burn using the rule of nines now!

7 burns

7 burns

Editor’s Notes

First aid for burns

First aid for burns in children, what can and cannot be done

Types of burns

What to do if your child is burned

What not to do with burns

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