RULE OF NINES

The Rule of NinesTo approximate the percentage of burned surface area,

the body has been divided into eleven sections: Head

Right arm Left arm

Chest Abdomen

Upper back Lower back Right thigh

Left thigh Right leg (below the knee)

Left leg (below the knee)

Each of these sections takes about nine percent of the body's skin to cover it. Added all together, these sections account for 99 percent. The genitals make up the last one percent.

To apply the rule of nines, add up all the areas of the body that are burned deep enough to cause blisters or worse (2nd or 3rd degree burns). For example, the entire left arm and the chest covered in blisters would be 18 percent. Partial areas are approximated. For example, the face is only the front half of the head and would be considered 4.5 percent.

Since kids are shaped so much different than adults, there are adjustments made to the rule of nines, which of course ruins the point of making this tool the rule of nines. So many variations exist that it would be fruitless to go into them here.

The most important thing to remember about the rule of nines is that it is intended to be used in the field to quickly determine if victims need to go to a specialty burn center. Once the victim is in a burn center, more advanced techniques will be used to determine the exact burned surface area.

The rule of nines assesses the percentage of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit.

You can estimate the body surface area on an adult that has been burned by using multiples of 9.

An adult who has been burned, the percent of the body involved can be calculated as follows:

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.

Total body surface area (TBSA) is an assessment measure of burns of the skin. In adults, the "rule of nines" is used to determine the total percentage of area burned for each major section of the body.[1] In some cases, the burns may cover more than one body part, or may not fully cover such a part - in these cases, burns are measured by using the casualty's palm as a reference point for 1% of the body.

For children and infants, the Lund-Browder chart is used to assess the burned body surface area. Different percentages are used because the ratio of the combined surface area of the head and neck to the surface area of the limbs is typically larger in children than that of an adult.[2]

BURNS

How to treat Burns Determine the severity of the burn. Your approach to

treatment will vary depending upon how badly the victim has been burned.[1]

First degree burn - This is the least severe burn and only involves the outer layer of skin (the epidermis). The skin will often be somewhat red and painful. Sunburns are usually first degree burns.Second degree burn - Second degree burns occur when the epidermis has been burned through and the second layer of skin (the dermis) has also been burned. These are much more painful than first degree burns and are usually accompanied swelling and blisters. A bad sunburn or a sunburn on someone with very light skin can be considered a 2nd degree burn. If this is the case, do not be alarmed if the blisters are yellow in color; although gross, they will pop normally and there will be new skin underneath. 2nd degree burns related to the sun may or may not swell.Third degree burn - The most severe type of burns, third degree burns occur when all the layers of the skin are burned through and the burn has reached the underlying tissue. Because the nerves have been destroyed, third degree burns are painless; skin will be dry and leathery, and frequently black, white or brown in color.[2]

Treatment of Minor Burns First degree and second degree burns that are fewer than three

inches in diameter are generally considered minor burns.[1] These types of burns usually heal quickly with minimal care. Follow these steps to administer first aid for minor burns.

Immerse the burn in cool or cold water. Ideally, you should hold the burned area under cold running water for about five minutes (or till the pain goes away). Do not put ice on the burn, as this can cause further damage to the skin.

Do not put on a bandage. Bandages will cut off air so it will take longer to heal.

Take an analgesic (pain reliever). Any of the common over-the-counter pain relievers will work.

Look out for signs of infection. Infection is uncommon with burns of this type, but is possible if blisters pop and are exposed to dirt.

Treatment of Major Burns Second degree burns covering a larger area, third degree burns

and any significant burns on the face, hands, feet, groin, a large joint (e.g., knee or elbow) should be treated as major burns.[1] With all major burns, seek medical help as soon as possible. Follow the steps below to care for these burns until you can get the injured person into the care of a doctor.

Call for emergency services immediately. Do not remove any embedded charred clothing or

material. Removing clothing from burned areas is likely to cause bleeding.[3] However, if not stuck to the burn, you should remove jewelry and unburned clothing if may constrict the burned area.[4]

Apply cool, wet compresses to the burned area for a very brief period of time.[4]. This will reduce body temperature somewhat. However, do not use ice or immerse the affected area in cold water for extended periods of time.

Be prepared to treat the burn victim for shock. Look for shock symptoms: weak, rapid pulse, clammy skin, disorientation or unconsciousness, nausea, combativeness.

Cover the burned area with cool, moist, sterile bandages.[1]

If possible, elevate the burn above the heart. This procedure will assist in reducing the likelihood or severity of shock.

Stay with the victim until help arrives.

Warnings Do not treat major/serious burns using lotion, cream, oil,

shortening (grease), butter or any other ointments. › Such first aid slows down medical treatment because it will

need to be removed when proper medical care begins on the damaged areas.

Chemical "burns" should be flushed with clean water for several minutes. Any contaminated clothing/articles will need to be removed immediately.

Some dry caustic materials should be lightly scraped or brushed off with a paper tissue. Adding water to these burns may cause more burning.

See a doctor as soon as possible for any severe burns because they will not heal properly without medical care and are beyond the scope of this article.

Burns from "radioactive" material are a whole different matter.

First Aid Regardless of the cause, the first step in managing a person with a

burn is to stop the burning process at the source, and cool the burn wound (but not the patient. It is essential to avoid the "lethal triad" of hypothermia, acidosis and coagulopathy).[18] For instance, with dry powder burns, the powder should be brushed off first. With other burns the affected area should be rinsed thoroughly with a large amount of clean water. Cold water should not be applied to a person with extensive burns for a prolonged period (greater than 20 minutes), however, as it may result in hypothermia. Do not directly apply ice to a burn wound as it may compound the injury. Iced water, creams, or greasy substances such as butter, should not be applied either.[19]

To help ease pain people may be placed in a special burn recovery bed which evenly distributes body weight and helps to prevent painful pressure points and bed sores. Survival and outcome of severe burn injuries is remarkably improved if the patient is treated in a specialized burn center/unit rather than a hospital.

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