**4. The burn patient evaluation (BPE)**

When performing the BPE, the "rule of nines" is a quick way to get an approximate estimate of burn size in the field in order to properly communicate the state of a patient over the radio to the accepting facility and initiate early goal directed therapy. When calculating TBSA of partial and full thickness burns on adults, the following body surface percentages are assigned to the corresponding anatomic regions (**Figure 2**):


When compared to adults, children have disproportionately larger heads [71], thus requiring an adjusted allotment of body surface area per anatomic region (**Figure 2**). Consequently, the adjusted percentages for TBSA evaluation in a child are:

#### **Figure 2.**

*(A) Left, diagram showing body surface area allocations for adult burn patients; (B) right, schematic representation of body surface area allocations for pediatric burn patients.*

**147**

Total

**Table 2.**

*Burn Shock and Resuscitation: Many Priorities, One Goal*

Another quick TBSA estimation technique is to use an area equal to the patient's own palm (with extended fingers) as an equivalent of approximately 1% TBSA. This measuring standard is then applied to each burned area and is especially useful in

During the secondary BPE, especially after full exposure is completed, a better estimation of TBSA can be obtained to more precisely direct further hemodynamic and fluid resuscitation. In the 1940s, Lund and Browder introduced a seminal paper on estimating burn size and provided a simple chart that breaks down TBSA of smaller areas of the body for different age groups [71, 74]. This method is

> **10–14 years**

*Lund and Browder's chart for calculating %TBSA of varying age groups, with sufficient granularity to provide* 

*adequate accounting of the size and depth of the patient's burns, categorized by anatomic area.*

**15 years** **Adult %2° %3° %TBSA**

*DOI: http://dx.doi.org/10.5772/intechopen.85646*

• Heads and neck combined are 18%

• Anterior trunk is 18%

• Posterior trunk is 18%

**Area 0–1** 

**years**

• Each upper extremity is 9%

• Each lower extremity is 14%

cases of patchy injury distribution [72, 73].

**1–4 years**

**5–9 years**

Head 19 17 13 11 9 7 Neck 2 2 2 2 2 2 Ant trunk 13 13 13 13 13 13 Post trunk 13 13 13 13 13 13 R buttock 2.5 2.5 2.5 2.5 2.5 2.5 L buttock 2.5 2.5 2.5 2.5 2.5 2.5 Genitalia 1 1 1 1 1 1 R arm 4 4 4 4 4 4 L arm 4 4 4 4 4 4 R forearm 3 3 3 3 3 3 L forearm 3 3 3 3 3 3 R hand 2.5 2.5 2.5 2.5 2.5 2.5 L hand 2.5 2.5 2.5 2.5 2.5 2.5 R thigh 5.5 6 6.5 8 8.5 9 L thigh 5.5 6 6.5 8 8.5 9 R leg 5 5 5.5 6 6.5 7 L leg 5 5 5.5 6 6.5 7 R foot 3.5 3.5 3.5 3.5 3.5 3.5 L foot 3.5 3.5 3.5 3.5 3.5 3.5 *Burn Shock and Resuscitation: Many Priorities, One Goal DOI: http://dx.doi.org/10.5772/intechopen.85646*


*Clinical Management of Shock - The Science and Art of Physiological Restoration*

When performing the BPE, the "rule of nines" is a quick way to get an approximate estimate of burn size in the field in order to properly communicate the state of a patient over the radio to the accepting facility and initiate early goal directed therapy. When calculating TBSA of partial and full thickness burns on adults, the following body surface percentages are assigned to the corresponding anatomic

When compared to adults, children have disproportionately larger heads [71], thus requiring an adjusted allotment of body surface area per anatomic region (**Figure 2**). Consequently, the adjusted percentages for TBSA evaluation in a child are:

*(A) Left, diagram showing body surface area allocations for adult burn patients; (B) right, schematic* 

*representation of body surface area allocations for pediatric burn patients.*

**4. The burn patient evaluation (BPE)**

regions (**Figure 2**):

• Neck is 1%

• Entire head is 9%

• Anterior trunk is 18%

• Posterior trunk is 18%

• Each upper extremity is 9%

• Each lower extremity is 18%

**146**

**Figure 2.**


Another quick TBSA estimation technique is to use an area equal to the patient's own palm (with extended fingers) as an equivalent of approximately 1% TBSA. This measuring standard is then applied to each burned area and is especially useful in cases of patchy injury distribution [72, 73].

During the secondary BPE, especially after full exposure is completed, a better estimation of TBSA can be obtained to more precisely direct further hemodynamic and fluid resuscitation. In the 1940s, Lund and Browder introduced a seminal paper on estimating burn size and provided a simple chart that breaks down TBSA of smaller areas of the body for different age groups [71, 74]. This method is


#### **Table 2.**

*Lund and Browder's chart for calculating %TBSA of varying age groups, with sufficient granularity to provide adequate accounting of the size and depth of the patient's burns, categorized by anatomic area.*

considered to be the most accurate and reliable method of determining TBSA, with only a few caveats. More specifically, patient populations that may not be accurately represented by Lund and Browder's chart include the morbidly obese, amputees, women with large breasts, and gravid women (**Table 2**) [71, 75].
