Rule of nines for area, Parkland formula for fluid
Expansion
Rule of nines in adults
- Head and neck - 9 per cent
- Each arm - 9 per cent
- Each leg - 18 per cent
- Front of trunk - 18 per cent
- Back of trunk - 18 per cent
- Perineum - 1 per cent
The patient’s whole palm including fingers is about 1 per cent, useful for scattered burns.
Children differ: the head is proportionally larger (about 18 per cent in an infant) and the legs smaller, so the Lund and Browder chart is used.
Parkland formula: 4 ml x body weight in kg x percentage burn, of Hartmann’s, in the first 24 hours from the time of the burn, with half given in the first 8 hours.
Do not include simple erythema in the percentage.
Depth
- Superficial - red, painful, blanches. Heals in days
- Superficial partial thickness - blisters, very painful, blanches
- Deep partial thickness - mottled, less painful, does not blanch
- Full thickness - white or leathery, painless, does not blanch
Suspect inhalation injury with facial burns, singed nasal hair, soot in the mouth, hoarseness or stridor, or a fire in an enclosed space; intubate early, before oedema makes it impossible.
Circumferential burns of the limb or chest may need escharotomy.