A 34-year-old plumber weighing 80 kg is brought to the emergency department 30 minutes after a commercial water heater exploded at a job site. He is awake and in significant pain. Vital signs show a heart rate of 110/min, blood pressure of 130/85 mm Hg, and respiratory rate of 20/min. Physical examination reveals second- and third-degree thermal burns involving his entire anterior trunk, his entire right arm, and the anterior surface of his right leg. There is no facial involvement or singed nasal hairs. The remainder of his skin is unaffected. Using the Rule of Nines for adults, what is the estimated total body surface area (TBSA) percentage affected by these burns?
Answer: 36 %
Answer
36
The patient has second- and third-degree burns which are appropriately included in TBSA calculations (superficial or first-degree burns are excluded). According to the adult Rule of Nines, the head is 9%, each entire arm is 9%, the anterior trunk is 18%, the posterior trunk is 18%, each entire leg is 18%, and the perineum is 1%. This patient has burns on the entire anterior trunk (18%), the entire right arm (9%), and the anterior surface of the right leg (9%, which is exactly half of the entire 18% leg). Summing these areas yields: .
Step-by-Step Solution
Key Concept
Estimating Total Body Surface Area (TBSA) in burn patients using the adult Rule of Nines.