Burns (cont.)
What is the significance of the amount of body area burned?
In addition to the depth of the burn, the total area of the burn is
significant. Burns are measured as a percentage of total body area affected. The
"rule of nines" is often used, though this measurement is adjusted for infants
and children. This calculation is based upon the fact that the surface area of
the following parts of an adult body each correspond to approximately 9% of total
(and the total body area of 100% is achieved):
- Head = 9%
- Chest (front) = 9%
- Abdomen (front) = 9%
- Upper/mid/low back and buttocks = 18%
- Each arm = 9%
- Each palm = 1%
- Groin = 1%
- Each leg = 18% total (front = 9%, back = 9%)
As an example, if both legs (18% x 2 = 36%), the groin (1%) and the front chest and abdomen were burned, this would involve 55% of the body.
Only
second and third degree burn areas are added together to measure total body burn
area. While first degree burns are painful, the skin integrity is intact and it
is able to do its job with fluid and temperature maintenance.
If more than15%-20% of the body is involved in a burn,
significant fluid may be lost. Shock may occur if inadequate fluid is not provided intravenously. The
Parkland formula (named for the trauma hospital in Dallas) estimates the amount
of fluid required in the first few hours of care following a burn:
- 4cc/ kg of weight/% burn = initial fluid requirement in the first 24 hours,
with half given in the first 8 hours.
- As an example: A 175lb (or 80kg) patient with 25% burn will need 4cc x 80kg
x 25%, or 8000cc of fluid in the first 24 hours, or more than 7 pounds of fluid.
As the percentage of burn surface area increases, the risk of death increases
as well. Patients with burns involving less than 20% of their body should do
well, but those with burns involving greater than 50% have a significant
mortality risk, depending upon a variety of factors, including underlying
medical conditions and age.
Next: How important is the location of a burn? »
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