Rule of nines. Left, Anterior view. Right, Posterior view.
RULE OF 1’S
The rule of 1’s calculates a burn size score (BSS). Under this rule the head, anterior torso, posterior torso, genitals, each arm, and each leg are worth 1 point. If the area is burned >50%, a 1 is assigned. If the area is burned <50%, a 0.5 is assigned. The points are added and rounded up. For example, a man with burns to the head, anterior chest, and bilateral arms has a BSS of 4. To calculate the amount of intravenous (IV) lactated Ringer’s (LR) needed per hour, use the following formula: 2.25 × BSS × weight (kg).
TRIAGE CATEGORIES
See Table 12-1 for triage categories, including priority, definition, and criteria. The following burns require referral to a burn unit:
• Partial thickness burns greater than 10% of TBSA
• Face, hands, feet, genitalia, perineum, or major joint burns
• Third-degree burns in any age group
• Electrical and chemical burns
• Inhalation injury
• Burns in patients with a pre-existing condition that could affect recovery
• Burns in patients with concomitant trauma (e.g., fractures)
• Burns in children receiving care in a hospital without adequate equipment or personnel to care for children
• Burns in patients who require social, emotional, or long-term rehabilitative intervention
| PRIORITY | COLOR | DEFINITION | CRITERIA |
|---|---|---|---|
| 1 | Red | Critically injured patients who require immediate care and treatment at a burn center | • TBSA >60%, with or without injury, inhalation injury • TBSA 40%-60% with inhalation injury • Infant TBSA >10% or children TBSA >15% • Any pediatric patient with inhalation injury |
| 2 | Yellow | Urgent patients who require treatment at a burn center | • TBSA 20%-60% and no inhalation injury • TBSA 0%-40% with inhalation injury • Infant TBSA <10% or children TBSA <15% |
| 3 | Green | Patients who do not meet American Burn Association criteria for treatment at a burn center | • TBSA 0%-20% and no inhalation injury |
| 4 | Black | Patients with a poor prognosis for survival | • Deceased or cardiac arrest • Patients with all burns >40%, age >60 years, and inhalation injury |
THERMAL INJURY MANAGEMENT
A thermal injury can result from a flame or steam and can cause denaturation of body proteins. This process breaks down the functions of the skin, such as regulating both bodily fluids and temperature, and maintaining a protective barrier against foreign pathogens. Burns are further classified into first-degree, second-degree, and third-degree burns depending on the extent of their severity. The severity of a thermal injury is determined by the following:
• The temperature of the agent
• The length of exposure to the agent
• The thickness of the area exposed
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