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are usually fatal to adults without immediate treatment.
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3-15. BURN DEPTH ESTIMATE
a. Scald Burn. A scald on the bare skin of an adolescent or an adult is
probably superficial. The reason is that heat dissipates rapidly. In a child or an elderly
person, the burn may involve the additional dermal layers of skin.
b. Hot Grease Burn. A burn caused by hot grease is probably a full-thickness
burn. This is because grease cools slowly and is difficult to remove. Hot grease on the
skin may cause extensive and deep damage before anyone can get it off the skin.
c. Electricity/Chemical Burns. Burns caused by electricity or chemicals are
almost always full-thickness burns.
3-16. THERMAL BURNS: THE RULE OF NINES
The severity of thermal injury depends on the depth and extent of the burn.
These two factors determine not only mortality and initial treatment requirements, but
the character of healing, functional result, and the consequences on the body of the
injury.
a. The Rule of Nines. The Rule of Nines is a quick way to calculate the amount
of skin surface that has been burned. The name comes from the fact that various
regions of the adult anatomy are assigned nine percent of the body surface or multiples
of nine. (The Rule of Nines is also used to determine the percent of a child's skin
surface with burns. The percentages assigned to a child's legs are not nines or
multiples of nines.) See figure 3-4 for percentages assigned to an adult's body and
figure 3-5 for percentages assigned to a child's body.
NOTE: Look at figure 3-4. Notice that although the upper extremities are listed as
totaling 18% of the total body surface area with each arm being 9%, the
front and back of the arms are further divided. The front of the arm is 4.5%,
and the back of the arm is 4.5%. The same is true for the lower extremities.
Each leg is 18%, but the leg front is 9%, and the leg back is 9%.
NOTE: See figure 3-5. Just as the body surface of an adult can be further divided, so
can the body surface area of the small child. Notice that while each upper
extremity equals 9%, the front of the arm is 4.5%, and the back of the arm is
4.5%. Similar subdivisions are made for the lower extremities.
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RULE OF NINES FOR ADULT BODY SURFACE BURNS
Head and neck equal ................... 9%
Anterior trunk equals ....................18%
Posterior trunk equals ..................18%
Upper extremities (each 9%)........18%
Lower extremities (each 18%)......36%
Perineum...................................... 1%
Figure 3-4. Rule of nines for adult body surface burns.
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RULE OF NINES FOR SMALL CHILD BODY SURFACE
Head and neck equal ...................18 %
Anterior trunk equals ....................18 %
Posterior trunk equals ..................18 %
Upper extremities (each 9%)........18 %
Lower extremities (each 13.5%)...27 %
Perineum...................................... 1 %
Figure 3-5. Rule of nines for small child body surface burns.
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b. Examples. Examples of calculating the percentage of burn are given in
figures 3-6 through 3-8.
EXAMPLE #1. A person sustained burns of the chest, abdomen,
and right arm.
PROBLEM: What percentage of the body was burned?
SOLUTION:
Chest (anterior trunk) = 9.0 %
Abdomen = 9.0 %
front right arm = 4.5 %
back right arm = 4.5 %
27.0 %
Figure 3-6. Calculating percentage of burn, example 1.
EXAMPLE #2. A small child was burned on the posterior trunk,
the back of the right arm, and the back of the right leg.
PROBLEM: What percentage of the body was burned?
SOLUTION:
Posterior trunk = 18.0 %
back right arm = 4.5 %
back right leg = 6.7 %
29.2 %
Figure 3-7. Calculating percentage of burn, example 2.
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EXAMPLE #3. An adult is burned on the anterior trunk, the right
arm, and the left arm.
PROBLEM: What percentage of the body was burned?
SOLUTION:
Anterior trunk = 18 %
Right arm (front and back) = 9 %
Left arm (front and back) = 9 %
36 %
Figure 3-8. Calculating percentage of burn, example 3.
3-17. THERMAL BURNS: MANAGEMENT
a. History. Observe the scene of the injury. Find out how long the burn
occurred before help arrived. Try to obtain the answers to the following questions.
(1) What has the patient or bystanders done for the injury?
(2) Was the patient in a closed space with smoke, steam, or other products
of combustion? If so, for how long? Did the patient lose consciousness?
(3) What was the cause of the burn? Open flame? Hot liquids?
(4) Does the patient have any history of significant heart disease which
might complicate fluid therapy? Pulmonary problems which might cause a reaction to
smoke inhalation? Other underlying illnesses?
b. General Treatment.
(1) Remove the casualty from the source of the burn. Smother any flames
and turn off the electrical source. Extinguish and cut off burning clothes. That is,
generally, eliminate the cause of the burn.
(2) Maintain the airway, continually assessing for patency (making sure the
airway is open).
(3) Administer humidified oxygen.
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(4) Assess vital signs.
(5) Remove the patient's clothing and constrictive articles such as rings and
bracelets. Clothing may continue to smolder, so cut it away. DO NOT pull away
clothing that is stuck to the skin. Cut around the stuck clothing.
(6) Evaluate the casualty for other injuries such as hemorrhage or central
nervous system injury.
(7) Treat for shock. Start an IV to replace body fluids. Use a large-bore
catheter. For burns that are greater than 20 percent of the TBSA and for significant
electrical burns, perform gastric intubation. (Later in this lesson, you will be instructed
how to determine the amount of fluid to give, depending on the casualty's body weight
and the total body surface area burned.)
(8) Perform urinary catheterization if the burns are greater than 20 percent
of the body surface and the patient has significant electrical burns.
(9) Keep the casualty warm at all times.
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