A patient comes in the emergency department with burn injury on one arm and whole back. According to rule of 9 calculate the burn area in TBSA?

1. A

   27%

2. B

   36%

3. C

   18%

4. D

   9%

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

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• The Rule of Nines is a standardized method to quickly estimate the Total Body Surface Area (TBSA) affected by a burn in adults.
• According to this rule, the entire back (posterior trunk) accounts for 18% of the TBSA.
• Each full arm (from shoulder to hand) accounts for 9% of the TBSA.
• Therefore, the total burn area is the sum of the back and one arm: 18% + 9% = 27%.

Why Other Options Were Wrong

• Option B: This value is an overestimation. 36% would represent the entire trunk (anterior and posterior) or both legs combined.
• Option C: This value is an underestimation. 18% represents only the back (posterior trunk) or one full leg, but it omits the burn on the arm.
• Option D: This value is a significant underestimation. 9% represents only the burn on one arm, but it omits the much larger burn on the back.

Related Visual

• Visual 1: Diagram: An illustration of the 'Rule of Nines' for adults, showing the percentage of body surface area for each major body part. This helps visualize the calculation.
• Visual 2: Flowchart: A flowchart demonstrating the steps for initial burn management in the emergency department, starting with TBSA assessment, followed by fluid resuscitation calculation and administration.

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Calculation of Total Body Surface Area (TBSA) using the Rule of Nines for an adult burn patient in acute care settings.
• Accurate TBSA calculation is a critical first step in burn management as it directly influences the volume of intravenous fluids required for resuscitation, guided by formulas like the Parkland (Baxter) formula.
• An incorrect TBSA estimation can lead to either under-resuscitation (risking hypovolemic shock and organ failure) or over-resuscitation (risking pulmonary edema and compartment syndrome).
• The TBSA percentage helps classify the burn's severity, which determines the level of care required, including whether the patient needs to be transferred to a specialized burn center.

How to Approach the Question

• First, identify the key information provided in the question: the patient is an adult, and the burned areas are 'one arm' and the 'whole back'.
• Recall the 'Rule of Nines' percentages for an adult. The provided image can be used as a reference.
• Assign the correct percentage to each burned body part based on the rule: one full arm is 9%, and the whole back (posterior trunk) is 18%.
• Sum the percentages for all the burned areas to find the total TBSA: 9% + 18% = 27%.
• Compare your calculated total with the given options and select the one that matches.

Concept Tested & Keywords

• Concept Tested: Calculation of Total Body Surface Area (TBSA) using the Rule of Nines for an adult burn patient.
• Stem keywords: burn injury, one arm, whole back, rule of 9, TBSA
• Lead-in keywords: calculate
• Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.

Question ID

QLhA6BxzUa7MJkP3LTBm9F

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