If both arms of a patient are burned, the nursing officer/CHO has to calculate the percentage of their body that is burned using the Rule of Nines?

1. A

   9%

2. B

   36%

3. C

   18%

4. D

   1%

Appeared in: Uttarakhand CHO - 2021

Explanation

• The Rule of Nines is a standardized method to quickly estimate the Total Body Surface Area (TBSA) affected by a burn in adults.
• In this system, each full arm is assigned a value of 9% of the total body surface.
• Therefore, burns covering both arms are calculated as 9% (for the first arm) plus 9% (for the second arm), which totals 18%.

Why Other Options Were Wrong

• Option A: This value is incorrect because 9% represents the TBSA for only a single arm, not both.
• Option B: This value is incorrect. 36% represents the TBSA for the entire trunk (anterior and posterior surfaces combined) or for both legs combined.
• Option D: This value is incorrect. 1% represents the TBSA of the perineal (genital) area.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Calculation of Total Body Surface Area (TBSA) using the Rule of Nines for burns to guide bedside assessment, documentation, and the next nursing action.
• Accurate TBSA calculation using the Rule of Nines is a critical first step in managing moderate to severe burns, as it directly influences the volume of intravenous fluids required for resuscitation.
• Underestimation of TBSA can lead to inadequate fluid replacement and burn shock, while overestimation can cause fluid overload, pulmonary edema, and compartment syndrome.
• The TBSA percentage is a key variable in the Parkland (or Baxter) formula (4 mL x kg of body weight x %TBSA) to determine the amount of intravenous fluids needed in the first 24 hours post-burn.

How to Approach the Question

• First, identify the key elements of the question: the method to be used ('Rule of Nines') and the specific area affected ('both arms').
• This is a factual recall question that requires knowledge of standardized medical calculations.
• Recall the percentage assigned to a single arm in the adult Rule of Nines, which is 9%.
• Since the question specifies 'both arms', perform the simple addition: 9% + 9%.
• The result is 18%. Match this result with the provided options to find the correct answer.

Concept Tested & Keywords

• Concept Tested: Calculation of Total Body Surface Area (TBSA) using the Rule of Nines for burns.
• Stem keywords: both arms, burned, Rule of Nines, percentage
• Lead-in keywords: calculate

Question ID

Qb0Rb66ADeeoEKoAkvam4Z

Copy ID

Reference Book

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