Examkin

Question

Difficulty: MediumTrauma and Burns

A 42-year-old man is brought to the emergency department after being rescued from a house fire. On primary survey, his airway is patent, breathing is spontaneous, and breath sounds are equal bilaterally. Vital signs are temperature 37.1∘C37.1^\circ\text{C} (98.8∘F98.8^\circ\text{F}), pulse 115/min115/\text{min}, respirations 22/min22/\text{min}, and blood pressure 110/70 mmHg110/70\text{ mmHg}. Physical examination reveals deep, blistered, weeping skin as well as charred, leathery eschar over his entire head and neck, his entire anterior trunk, his entire left arm, and the anterior surface of his left leg. The skin of his entire right arm is erythematous, dry, and painful to touch but lacks blisters. Based on the Rule of Nines, what is the calculated total body surface area (TBSA) percentage that should be used to guide his initial fluid resuscitation?

Answer: 45 %

Answer

45
The correct TBSA is 45% because the calculation must only include deep partial-thickness and full-thickness burns. These correspond to the head and neck (9%), the anterior trunk (18%), the entire left arm (9%), and the anterior left leg (9%). The superficial burns on the right arm are excluded from resuscitation calculations.

Step-by-Step Solution

1
Determine burn depth for each affected region.
The head, anterior trunk, left arm, and anterior left leg have second- or third-degree burns. The right arm has first-degree burns.
Only partial-thickness (second-degree) and full-thickness (third-degree) burns are included in TBSA calculations for fluid resuscitation.
2
Apply the Rule of Nines to the qualifying body regions.
Head/neck = 9%, anterior trunk = 18%, entire left arm = 9%, anterior left leg = 9%.
Standard adult TBSA estimation divides the body into specific anatomical sections of 9% or multiples thereof.
3
Calculate the total percentage.
9 + 18 + 9 + 9 = 45%.
Summing the qualifying regions provides the correct TBSA required for determining fluid resuscitation needs.

Key Concept

Total Body Surface Area (TBSA) calculation using the adult Rule of Nines
Rate this question

Topics

Trauma and Burns

More questions from this topic