Rule of Nines question........

  1. Rule of Nines question........

    I am confused!!
    I would appreciate any help as I cannot work it out!!

    I am doing a burns case study, and we have to work out the suface area of the burns the patient suffered. I know that the 'Rule of Nines' would be used, or the Lund and Browder chart, but I am still confused!?!
    What I don't understand is in the rule of nines, if a person is burnt on both arms, would they get a '9', or an '18' % score? Or if they were only burnt on 1 arm, would they get a 4.5% score. I am soooo confused, I have looked in my texts, on the 'net, but nothing specifically states this. Thank you!

    bew
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  2. 13 Comments

  3. by   aus nurse
  4. by   2ndCareerRN
    Not being a burn nurse, but an ER nurse, we just try to get a quick and dirty initial assessment of the burns.

    A rule of nines chart is very helpful. Some charts use a 1 view with the total for the 1 arm being 9% (that is front and back).

    something like this one: http://usitweb.shef.ac.uk/~mda00gcb/nines.htm

    I prefer to use a chart where the front and back are seperate. This way the front of the arm is 4.5% and the back is 4.5%. I feel it gives a much more accurate assesment of the involvement.

    something like this: http://www.webhealthcentre.com/general/fa_burns.asp

    There are even charts that break down the areas even more... but I have rarely seen them.

    To answer your question, if the patient had total involvement of bilat arms, he would score an 18%. But you also have to take into account how much of each area is burned. If only 1/2 of one arm was burned it would be 4.5%.
    The thing to do is look at the chart, figure out the % the area that is burned, and then estimate the amount of burn (% of involvement) on that area.

    At least that is the way that I estimate burns for an ER assessment, it gives a quick idea of how much involvement there is. And you must remember that the pediatric charts are diffeent from the adult one.

    I hope I didn't make this even muddier for you.

    bob
  5. by   aus nurse
    Oh my gosh...I didn't mean it to be THAT big
    Sorry Brian for taking up so much bandwith. Feel free anyone to make it smaller if anyone knows how

    So Bewbew, if a person is burnt on both ams only he/she would score 18 %. The total body proportions add up to 100% as you see in this almighty big chart

    This is for adults...the Lund Browder is used more commonly for kids as their head/neck area is bigger in proportion at that age.

    Hope this helped
  6. by   aus nurse
    My my I am still embarrassed about that huge chart lol:imbar

    A good rule of thumb for a very quick assessment too is that your patient's palm equals approx 1% of total body surface.

    BTW I am not a burns nurse either..so I happily bow to others if they are more informed or up to date than me.
  7. by   babynursewannab
    aus nurse:

    DANG! Make a POINT or something!!! :chuckle

    That was too freakin' hilarious! I can't stop laughing!
  8. by   sunnygirl272
    my...what a handsome 1% he has....
  9. by   bewbew
    Thank you for the help............thanks for the BRILLIANT links, Bob, and thanks Ausnurse for the BIG diagram!!

    I am still laughing too, and yes, sunnygirl272, it IS a handsome 1% !!!!!

    bew
  10. by   andrewsgranny
    You think some people (men) have more than just 1%
  11. by   oldgirl
    Oh my gosh-looks to me like the 1% MELTED!!!!!!!!!!!!!!!
  12. by   sunnygirl272
    Originally posted by oldgirl
    Oh my gosh-looks to me like the 1% MELTED!!!!!!!!!!!!!!!
    lol..he shoulda used some of night owl's conditioner....
  13. by   Mkue
    Originally posted by aus nurse
    My my I am still embarrassed about that huge chart lol:imbar

    A good rule of thumb for a very quick assessment too is that your patient's palm equals approx 1% of total body surface.

    BTW I am not a burns nurse either..so I happily bow to others if they are more informed or up to date than me.
    Don't be embarrassed !! It's GREAT !! thanks
  14. by   night owl
    Here you go you poor (little) dear, This will make it allllll better!

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