A 23 year old man comes to the emergency department with thermal burns. In this case according to rule of nine which part of the body burned maximum?

1. A

   Upper trunk

2. B

   Face and neck

3. C

   Upper arm and perineum

4. D

   Upper leg and perineum

Appeared in: PGIMER NO - 2020

Explanation

• The Rule of Nines is a method to quickly estimate the Total Body Surface Area (TBSA) of a burn in adults.
• According to this rule, an entire leg accounts for 18% of TBSA. Therefore, the upper leg (thigh) is considered 9%.
• The perineum (genital area) is assigned 1% of the TBSA.
• Combining the upper leg (9%) and the perineum (1%) gives a total of 10% TBSA.
• This 10% value is the highest when compared to the other options: Upper trunk (9%), Face and neck (9%), and Upper arm and perineum (5.5%).

Why Other Options Were Wrong

• Option B: The 'upper trunk' typically refers to either the anterior chest or the posterior upper back, each accounting for 9% of TBSA. This is less than the 10% calculated for the correct option.
• Option C: The entire head and neck region is assigned 9% of the TBSA according to the Rule of Nines. This is less than the 10% of the correct option.
• Option D: An entire arm is 9%, making the upper arm 4.5%. When combined with the perineum (1%), the total TBSA is only 5.5%, which is the lowest value among all the options.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Application of the Rule of Nines for burn assessment in adults as background academic context rather than a clinical decision trigger.
• Accurate TBSA estimation is critical for calculating fluid resuscitation needs, most commonly using the Parkland formula (4 mL x body weight in kg x %TBSA).
• The TBSA percentage helps determine the severity of the burn, guides decisions on patient transfer to a specialized burn unit, and informs the overall plan of care.
• What if? - If the patient was a 1-year-old child, the Rule of Nines would be inaccurate due to different body proportions. The Lund-Browder chart would be used instead, which assigns a larger percentage to the head (around 17%) and a smaller percentage to the legs (around 13.5% each).

How to Approach the Question

• Identify the core concept being tested: The question requires the application of the 'Rule of Nines' to determine the largest burn area from a list of options.
• Recall the standard percentages for an adult using the Rule of Nines: Head/Neck (9%), each Arm (9%), Anterior Trunk (18%), Posterior Trunk (18%), each Leg (18%), and Perineum (1%).
• Systematically calculate the TBSA for each option provided. Remember to halve the percentage for partial limbs (e.g., an upper arm is 4.5%, an upper leg is 9%).
• For Option A: Upper leg (9%) + Perineum (1%) = 10%.
• For Option B: Upper trunk (chest) = 9%.
• For Option C: Face and neck = 9%.

Concept Tested & Keywords

• Concept Tested: Application of the Rule of Nines for burn assessment in adults.
• Stem keywords: thermal burns, Rule of Nines, maximum burn
• Lead-in keywords: which part
• Clinical cues: 23 year old man (indicates adult proportions for Rule of Nines)

Question ID

Q1-3VslJOWsMct7S-MtNg3

Copy ID

Reference Book

E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) p. 178-180