When a burn injury occurs, a rapid and accurate assessment is crucial for effective treatment. This involves estimating the Total Body Surface Area (TBSA) affected by the burn. This initial assessment is foundational for guiding subsequent medical decisions and significantly influences patient outcomes, providing immediate insight into the injury’s severity.
Methods for Calculating Burn Size
The “Rule of Nines” is a common method for rapidly estimating TBSA in adults. It divides the body into sections, each representing 9% or a multiple of 9% of the total body surface area. The head and neck account for 9%, each arm (including the hand) is 9%, the front of the torso is 18%, the back of the torso is 18%, each leg (including the foot) is 18%, and the perineum (genital area) is 1%. This standardized approach allows for quick visual summation of affected areas, useful in emergency settings.
For children, whose body proportions differ from adults, the Lund-Browder Chart is often preferred. This method adjusts TBSA percentages for body parts based on the patient’s age. The chart allows medical professionals to outline burned areas and calculate the percentage based on age-specific proportions, offering a more accurate estimate for pediatric patients. For instance, the head represents a larger percentage of TBSA in infants compared to adults, while the legs account for a smaller percentage.
The “Palm Method,” or Rule of Palms, provides a quick estimation for smaller or scattered burns. The patient’s palm, including fingers, represents approximately 1% of their TBSA. This technique is practical for irregularly shaped or patchy burn areas when detailed charts are cumbersome. While useful for rapid assessment, it is a rough estimate, as actual palm size can vary from the precise 1% figure.
Why Accurate Calculation is Crucial
Accurate TBSA calculation influences immediate and long-term patient care. It determines the necessary volume of intravenous fluids for resuscitation, preventing burn shock. The Parkland formula, a widely used guideline, calculates fluid requirements based on patient weight and estimated TBSA, with half the total fluid administered in the first eight hours and the remainder over the next sixteen hours.
The calculated TBSA also predicts prognosis and guides specialized care decisions. A higher TBSA correlates with more severe injury, indicating the need for transfer to a dedicated burn center. For instance, partial-thickness burns exceeding 10% TBSA or any full-thickness burns warrant specialized burn center treatment. This assessment helps ensure patients receive the appropriate specialized care.
TBSA estimation also guides the correct dosage of medications, including pain management and other supportive therapies. The extent of the burn directly impacts the systemic response and metabolic demands, necessitating precise medication adjustments.
Understanding Burn Depth
While TBSA quantifies the extent of the burn, understanding burn depth is equally important for assessing severity and guiding treatment. Burn depth categorizes injuries based on which skin layers are affected, from superficial to full-thickness.
First-degree burns (superficial) affect only the outermost skin layer (epidermis). These burns appear red, are painful, dry, and do not blister, similar to a mild sunburn. They heal within days without scarring.
Second-degree burns (partial-thickness) extend through the epidermis into the dermis. These burns are characterized by redness, blistering, swelling, and can be very painful. Healing time and scarring potential vary depending on whether they are superficial or deep partial-thickness.
Third-degree burns (full-thickness) are the most severe, destroying epidermis and dermis, potentially extending into underlying fat, muscle, or bone. Affected skin may appear waxy white, leathery, charred black, or brown, with sensation absent due to destroyed nerve endings. These burns do not heal on their own and often require surgical intervention, such as skin grafting.
Immediate Care and When to Seek Medical Help
For immediate burn care:
Stop the burning process by removing the person from the heat source.
Cool the burn with cool, not cold, running water for 10 to 20 minutes to reduce pain and limit tissue damage.
Gently remove any clothing or jewelry near the burned area, unless stuck to the skin.
After cooling, loosely cover the burn with a clean, non-adhesive dressing to protect it from infection.
Seek professional medical help for:
Any third-degree burn, regardless of size, requires immediate medical attention.
Second-degree burns larger than the patient’s palm, or those involving sensitive areas like the face, hands, feet, genitals, or major joints, should be assessed by a healthcare provider.
Electrical or chemical burns necessitate urgent medical evaluation, as they can cause internal damage not immediately visible.
Signs of an inhalation injury, such as facial burns, singed nasal hairs, hoarseness, coughing, or difficulty breathing, also warrant immediate medical attention.