According to the Rule of Nines, what percentage of total body surface area (TBSA) is represented by the surface of one hand (including palm and fingers)?

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-2)

Explanation

The surface area of a patient's hand, including the palm and fingers, is estimated to be approximately 1% of their Total Body Surface Area (TBSA).
This estimation is commonly known as the 'Palm Method' or 'Rule of Palms'.
It is a practical tool used alongside the Rule of Nines, especially for assessing the extent of small, patchy, or scattered burns.
The Rule of Nines itself also allocates 1% to the perineum/genital area, and some interpretations group the hand into this 1% category for quick estimation.

Option A: 9% represents the TBSA for an entire arm (from shoulder to fingertips) or the entire head and neck in an adult.
Option B: 18% represents the TBSA for an entire leg, the entire front torso (chest and abdomen), or the entire back torso in an adult.
Option D: 10% is not a standard percentage used in the adult Rule of Nines for any major body part.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Estimation of Total Body Surface Area (TBSA) for burns as background academic context rather than a clinical decision trigger.
Accurate TBSA estimation is a critical nursing skill as it is the basis for calculating intravenous fluid requirements using formulas like the Parkland (Baxter) formula (4 mL x kg of body weight x %TBSA).
The calculated TBSA percentage helps determine the severity of the burn and guides decisions on patient management, including whether to transfer the patient to a specialized burn center.
What if? If a patient had scattered burns on their back that, when grouped together, were equivalent to the size of five of their hands, the TBSA would be estimated as 5%. This helps quantify irregular burn patterns.

How to Approach the Question

First, identify that the question is asking for a specific value related to burn assessment: the TBSA percentage of a hand.
Recall the standard methods for estimating TBSA: the Rule of Nines and the Palm Method.
Recognize that the Palm Method specifically addresses smaller areas like the hand.
Associate the patient's hand (including fingers) with 1% of their TBSA.
Evaluate the given options and select the one that matches this value.
Differentiate this from the larger percentages (9% and 18%) used for entire limbs or the torso in the Rule of Nines.

Concept Tested & Keywords

q7m-pEi0JtgUFz6-_xbXg

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 693-695

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 747-749

Practise the full NORCET 5 Prelims - Sept 2023 (Shift-2)

Attempt every question from this paper in a timed mock, then review the full solution for each one.