Tbsa Burn

No pain in burned area. TBSA: The TBSA burned is initially calculated using the Rule of Nines (Figure 1.) which provides a rapid assessment to begin treatment. This rule can be applied to both adults and pediatrics. If burns are scattered in small areas the Rule of Palms (Figure 2.) may be used, which estimates 1 percent TBSA burned based on the.

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  1. Facial burns, and burns over 40% Total Body Surface Area (TBSA). NOTE: Edema after burn injury causes most Supraglottic airway devices such as laryngeal mask airways (LMAs) to be inadequate.
  2. Surface Area (TBSA) Severity of burn injury is determined by the depth of injury, extent of body surface injured, location of burn on the body, age of the patient, pre-burn medical history and circumstances or complicating factors (e.g., smoke inhalation, other traumatic injuries).
  3. Burn TBSA abbreviation meaning defined here. What does TBSA stand for in Burn? Get the top TBSA abbreviation related to Burn.
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Authors
Phillip L Rice, Jr, MD
Dennis P Orgill, MD, PhD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Phillip L Rice, Jr, MD Nothing to disclose. Dennis P Orgill, MD, PhD Equity Ownership/Stock Options: HyperMed (Perfusion monitoring systems). Grant/Research/Clinical Trial Support: Acelity [Wound healing (VAC devices)]; Integra LifeSciences [Wound healing (Dermal regeneration template)]; ACell [Wound healing (Wound healing products)]; Medline [Wound healing (Wound healing products)]. Consultant/Advisory Boards: Acelity [Wound healing (VAC devices)]; Integra LifeSciences [Wound healing (Dermal regeneration template)]; Musculoskeletal Research Foundation (Wound healing products); Quthero [Wound healing (Wound healing products)]; Watermark Research Partners [Wound healing (Wound healing products)]; Geistlich Pharma AG [Wound healing (Wound healing products)]; Arch Therapeutics [Wound healing (Wound healing products)]; Bayer Germany [Wound healing (Wound healing products)]; Professional Education and Research Institute (PERI) [Wound healing (Wound healing continuing education)]. Marc G Jeschke, MD, PhD Nothing to disclose. Kathryn A Collins, MD, PhD, FACS Nothing to disclose.

Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence.

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Literature review current through: Apr 2021. This topic last updated: Feb 25, 2021.

INTRODUCTIONBurns are commonly thought of as injury to the skin caused by excessive heat. More broadly, burns result from traumatic injuries to the skin or other tissues primarily caused by thermal or other acute exposures. Burns occur when some or all of the cells in the skin or other tissues are destroyed by heat, electrical discharge, friction, chemicals, or radiation. Burns are acute wounds caused by an isolated, non-recurring insult, and healing ideally progresses rapidly through an orderly series of steps [1].

The mechanisms that result in burns and their classification will be reviewed here. The clinical assessment and management of burns in adults and children are discussed elsewhere. (See 'Treatment of minor thermal burns' and 'Treatment of superficial burns requiring hospital admission' and 'Overview of the management of the severely burned patient' and 'Treatment of deep burns'.)

BURN MECHANISMS

HeatThe depth of the thermal injury is related to contact temperature, duration of contact of the external heat source, and the thickness of the skin. Because the thermal conductivity of skin is low, most thermal burns involve the epidermis and part of the dermis [2]. The most common thermal burns are associated with flames, hot liquids, hot solid objects, and steam.

Electrical dischargeElectrical energy is transformed into heat as the current passes through poorly conducting body tissues. Electroporation (injury to cell membranes) disrupts membrane potential and function. The magnitude of the injury depends on the pathway of the current, the resistance to the current flow through the tissues, and the strength and duration of the current flow. (See 'Environmental and weapon-related electrical injuries'.)

FrictionInjury from friction can occur due to a combination of mechanical disruption of tissues as well as heat generated by friction.

ChemicalsInjury is caused by a wide range of caustic reactions, including alteration of pH, disruption of cellular membranes, and direct toxic effects on metabolic processes. In addition to the duration of exposure, the nature of the agent will determine injury severity. Contact with acid causes coagulation necrosis of the tissue, while alkaline burns generate liquefaction necrosis. Systemic absorption of some chemicals is life-threatening, and local damage can include the full thickness of skin and underlying tissues. (See 'Topical chemical burns: Initial assessment and management'.)

RadiationRadio frequency energy or ionizing radiation can cause damage to skin and tissues. The most common type of radiation burn is the sunburn. Radiation burns are most commonly seen today following therapeutic radiation therapy and are also seen in patients who receive excessive radiation from diagnostic procedures. (See 'Clinical manifestations, evaluation, and diagnosis of acute radiation exposure'.)

Radiation burns can be seen in individuals who work in the nuclear industry. Radiation burns are often associated with cancer due to the ability of ionizing radiation to interact with and damage DNA. The clinical results of ionizing radiation depend on the dose, time of exposure, and type of particle that determines the depth of exposure. Depending on the photon energy, radiation can cause very deep internal burns.

CLASSIFICATION BY DEPTHCutaneous burns are classified according to the depth of tissue injury. The depth of the burn largely determines the healing potential and the need for surgical grafting.

The traditional classification of burns as first, second, third, or fourth degree was replaced by a system reflecting the need for surgical intervention. Current designations of burn depth are superficial, superficial partial-thickness, deep partial-thickness, and full-thickness (table 1 and figure 1) [3]. The term fourth degree is still used to describe the most severe burns, burns that extend beyond the skin into the subcutaneous soft tissue and can involve underlying vessels, nerves, muscle, bone, and/or joints.

Burn wounds are not usually uniform in depth, and many have a mixture of deep and superficial components. A precise assessment of the depth of the burn wound may be difficult initially as burn wounds are dynamic and can progress as well as convert to deeper wounds, and as such may require several days for a final determination [3,4]. Thin skin, particularly on the volar surfaces of the forearms, medial thighs, perineum, and ears, sustains deeper burn injuries than suggested by initial appearance [4]. It is best to assume there are no shallow burns in these areas [5]. Children under the age of 5 and adults over the age of 55 are also more susceptible to deeper burns because of thinner skin [4-6].

Appropriate burn wound care may necessitate multiple treatment modalities for different parts of a burn wound depending on the burn depth of each injured part.

The American Burn Association (ABA) has published an educational resource that reviewed the classification and management of the burn wound. The classification system below is largely in agreement [1].

SuperficialSuperficial or epidermal burns involve only the epidermal layer of skin. They do not blister but are painful, dry, red, and blanch with pressure (picture 1). Over the next two to three days the pain and erythema subside, and by approximately day 4, the injured epithelium peels away from the newly healed epidermis. Such injuries are generally healed in six days without scarring. This process is commonly seen with sunburns.

Partial-thicknessPartial-thickness burns involve the epidermis and portions of the dermis. They are characterized as either superficial or deep.

Superficial partial thickness – These burns characteristically form blisters within 24 hours between the epidermis and dermis. They are painful, red, and weeping and blanch with pressure (picture 2). Burns that initially appear to be only epidermal in depth may be determined to be partial thickness 12 to 24 hours later. These burns generally heal in 7 to 21 days; scarring is unusual, although pigment changes may occur. A layer of fibrinous exudates and necrotic debris may accumulate on the surface, which may predispose the burn wound to heavy bacterial colonization and delayed healing. These burns typically heal without functional impairment or hypertrophic scarring.

Deep partial thickness – These burns extend into the deeper dermis and are characteristically different from superficial partial-thickness burns. Deep burns damage hair follicles and glandular tissue. They are painful to pressure only, almost always blister (easily unroofed), are wet or waxy dry, and have variable mottled colorization from patchy cheesy white to red (picture 3). They do not blanch with pressure. If infection is prevented and wounds are allowed to heal spontaneously without grafting, they will heal in two to nine weeks. These burns invariably cause hypertrophic scarring. If they involve a joint, joint dysfunction is expected even with aggressive physical therapy. A deep partial-thickness burn that fails to heal in two weeks is functionally and cosmetically equivalent to a full-thickness burn. Differentiation from full-thickness burns is often difficult.

Full-thicknessThese burns extend through and destroy all layers of the dermis and often injure the underlying subcutaneous tissue. Burn eschar, the dead and denatured dermis, is usually intact. The eschar can compromise the viability of a limb or torso if circumferential.

Full-thickness burns are usually anesthetic or hypo-aesthetic. Skin appearance can vary from waxy white to leathery gray to charred and black. The skin is dry and inelastic and does not blanch with pressure (picture 4). Hairs can easily be pulled from hair follicles. Vesicles and blisters do not develop.

Pale full-thickness burns may simulate normal skin except that the skin does not blanch with pressure. Features that differentiate partial-thickness from full-thickness burns may take some time to develop.

The eschar eventually separates from the underlying tissue and reveals an unhealed bed of granulation tissue. Without surgery, these wounds heal by wound contracture with epithelialization around the wound edges. Scarring is severe with contractures; complete spontaneous healing is not possible.

Extension to deep tissuesFourth-degree burns are deep and potentially life-threatening injuries that extend through the skin into underlying soft tissue and can involve muscle and/or bone.

EXTENT OF BURN INJURYA thorough and accurate estimation of burn size is essential to guide therapy and to determine when to transfer a patient to a burn center. Using one of the methods described below, the extent of burns is estimated and expressed as the total percentage of body surface area (ie, TBSA). Superficial (first-degree) burns are not included in percentage TBSA burn assessment.

The locations of partial-thickness and full-thickness burned areas are recorded on a burn diagram (figure 2). Burns with an appearance compatible with either deep partial-thickness or full-thickness are presumed to be full-thickness until accurate differentiation is possible.

Methods of estimationThe two commonly used methods of assessing percentage TBSA in adults are the Lund-Browder chart and 'Rule of Nines.' The Lund-Browder chart is the recommended method in children because it considers the relative percentage of body surface area affected by growth [3,7,8]. If the burn is irregular and/or patchy, the palm method may be more useful.

Superficial (first-degree) burns are not included in percentage TBSA burn assessment.

Lund-Browder – The Lund-Browder chart (figure 2) is the most accurate method for estimating TBSA for both adults and children. Children have proportionally larger heads and smaller lower extremities, so the percentage TBSA is more accurately estimated using the Lund-Browder chart (table 2 and figure 2).

Rule of Nines – For adult assessment, the most expeditious method to estimate TBSA in adults is the 'Rule of Nines' [9,10]:

Tbsa burn chart

The head represents 9 percent TBSA

Each arm represents 9 percent TBSA

Each leg represents 18 percent TBSA

The anterior and posterior trunk each represent 18 percent TBSA

Palm method – Small or patchy burns can be approximated by using the surface area of the patient's palm. The palm of the patient's hand, excluding the fingers, is approximately 0.5 percent of total body surface area, and the entire palmar surface including fingers is 1 percent in children and adults [11-13].

Accuracy of percentage TBSA estimatesIn several observational reports comparing the estimation of burn size at the referring hospital with the estimation at the receiving burn center, the size of larger burns was underestimated. This resulted in under-resuscitation at the referring hospital [14-16]. Early transfer to a burn center should be arranged when injuries meet the criteria for major burns (table 3). (See 'Emergency care of moderate and severe thermal burns in adults', section on 'Initial assessment and treatment'.)

The percentage TBSA burned may be underestimated in women with large breasts who have burns of the anterior trunk. A table based on the cup size of a brassiere is intended to complement the Lund-Browder chart for burn estimation in adults. In a review of 60 volunteers to determine the difference in percentage TBSA of the anterior trunk between males and females, large-breasted women (cup size D and greater) were found to have a significantly greater amount of percentage TBSA on the anterior chest compared with men (16 versus 11 percent) [17]. This additional percentage TBSA is concentrated on the pectoral region and represents 10 percent of TBSA as compared with 5 percent for men and 7 percent for women with smaller breasts. There was an equal distribution of anterior and posterior trunk TBSA in men but a 1.6:1 ratio in large-breasted women. For every increase in cup size, the TBSA of a woman's anterior trunk increases by a factor of 0.1, relative to the posterior trunk (figure 3).

In addition, a study in patients with obesity suggested that both the Rule of Nines and Lund-Browder diagrams underestimate the extent of burns involving the torso and overestimate the percentage of burns involving the extremities in the patients with obesity [18]. In this study, the patient's primary shape (android versus gynecoid) was important for determining the percentage TBSA in comparison to body mass index (BMI) and sex.

Assessment of indeterminate burn depthClinical assessment is the most common technique to assess the depth of a burn wound; however, it is accurate in only 60 to 75 percent of the cases, even when carried out by an experienced burn surgeon [19,20]. Making assessments of burn depth is difficult because there are both spatial and temporal changes in perfusion in actual burn patients as most burn patients have burns of various depths caused by their injury.

A variety of methods that aim to improve burn depth assessment are in development or in early clinical use. Experimentally, optical methods can predict burn depth with over 90 percent accuracy. Additional studies will help provide a better understanding as to which technologies will be of greatest clinical use. Examples of such technologies include the following [21-33]:

Laser Doppler analysis assays the velocity of blood cells in the superficial dermis. This is reported as an index and correlated with blood perfusion.

Indocyanine green is a dye that can be injected intravenously and can be imaged by the application of ultraviolet light showing both an arterial and venous phase. Cameras are available in most large hospitals, and these systems are commonly used to monitor skin perfusion in skin flaps.

Thermography also provides an index of perfusion based on the temperature of the tissue. This provides two-dimensional images of perfusion in large areas.

A number of dermoscopy techniques have also been reported to correlate nicely with burn depth.

Hyperspectral imaging uses multiple light frequencies to image deoxy and oxyhemoglobin in tissues and has been shown in animal models to accurately correlate with burn depth.

Additional tools that have been evaluated include a single-sided planar magnetic resonance (MR) imaging probe, a unilateral MR imaging sensor equipped with a 2D gradient coil system, novel uses of lasers (eg, optimal coherence tomography), spatial frequency domain imaging alone and in combination with laser speckle imaging, and videomicroscopy.

ANATOMIC LOCATION OF BURN INJURYThe location of a burn often directs treatment. Burns on the face, hands, feet, and genitalia as well as large burns in other areas of the body and those associated with inhalational injury are often referred to burn centers for specialized expertise (table 3).

Head and neck – (See 'Principles of burn reconstruction: Face, scalp, and neck'.)

Extremities – (See 'Principles of burn reconstruction: Extremities and regional nodal basins' and 'Primary operative management of hand burns'.)

Trunk – (See 'Principles of burn management: The breast' and 'Principles of burn reconstruction: Perineum and genitalia'.)

Respiratory tract – Superheated gases can cause burns to the respiratory system. More commonly, injury occurs from smoke exerting its effects through local chemical irritation. In addition, chemicals such as carbon monoxide or cyanide can lead to systemic toxicity. Direct thermal injury from hot smoke usually burns only the pharynx while steam can also burn the airway below the glottis. (See 'Inhalation injury from heat, smoke, or chemical irritants'.)

Tbsa Burned Using The Rule Of Nines

OVERALL SEVERITY OF BURN INJURYA combination of the burn mechanism, burn depth, extent, and anatomic location determine the overall severity of the burn injury, which provides general guidance for the preferred disposition and care of these patients (table 3).

Minor or mild burn injuryMinor or mild burns are those that can be treated in a physician's office or in an emergency department as an outpatient. (See 'Treatment of minor thermal burns'.)

Moderate burn injuryModerate burns would be those that require admission to a hospital but not to a burn center. These include superficial burns or deeper burns of limited extent. (See 'Emergency care of moderate and severe thermal burns in adults' and 'Treatment of superficial burns requiring hospital admission'.)

Tbsa burn chartTbsa Burn

Severe burn injurySevere burn injury can be defined as burns that should be referred to, and treated at, a designated burn center (table 3). (See 'Emergency care of moderate and severe thermal burns in adults' and 'Overview of the management of the severely burned patient' and 'Treatment of deep burns'.)

SOCIETY GUIDELINE LINKSLinks to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See 'Society guideline links: Care of the patient with burn injury'.)

SUMMARY

Lund And Browder Calculation

A burn is defined as a traumatic injury to the skin or other organic tissue primarily caused by heat or exposure to electrical discharge, friction, chemicals, and radiation. (See 'Introduction' above and 'Burn mechanisms' above.)

Cutaneous burns are classified according to the depth of tissue injury (table 1 and figure 1). The depth of the burn largely determines the healing potential and the need for surgical grafting. (See 'Classification by depth' above.)

Superficial or epidermal burns involve only the epidermal layer of skin.

Partial-thickness burns involve the epidermis and portions of the dermis.

Full-thickness burns extend through and destroy all layers of the dermis.

Deeper (fourth-degree) burns extend through the skin into underlying soft tissues such as fascia, muscle, and/or bone.

A thorough estimation of burn size is essential to guide therapy. The extent of the burn injury is expressed as a percentage of the patient's total body surface area (TBSA). Superficial (first-degree) burns are not included in percentage TBSA burn assessment. This estimation can be facilitated using a Lund-Browder chart, the Rule of Nines, or the palm method. The most accurate method of assessment of TBSA burn in children and adults is the Lund-Browder chart. The extent of large TBSA burns is often underestimated, and factors such as sex, body shape, and obesity can affect the assessment. (See 'Extent of burn injury' above.)

The anatomic location of a burn often directs treatment. Burns on the face, hands, feet, and genitalia as well as large burns in other areas of the body are often referred to burn centers for specialized expertise. (See 'Anatomic location of burn injury' above.)

A combination of the burn mechanism, burn depth, extent, and anatomic location helps determine the overall severity of the burn injury (minor, moderate, severe), which provides general guidance for the preferred disposition and care of these patients. (See 'Overall severity of burn injury' above.)

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  1. American Burn Association White Paper. Surgical management of the burn wound and use of skin substitutes. Copyright 2009. www.ameriburn.or (Accessed on January 04, 2010).
  2. Pham, TN, Girban, et al. Evaluation of the burn wound: Management decisions. In: Total Burn Care, 3rd edition, Herndon, D (Eds), Saunders Elsevier, Philadelphia 2007. p.119.
  3. Woodson LC, Sherwood ER, Aarsland A, et al. Anesthesia for burned patients. In: Total Burn Care, 3rd edition, Herndon DN (Ed), Saunders Elsevier, Philadelphia 2007. p.196.

When we’re looking at burns, we’re going to be looking at four main factors. The type of burn, the amount of surface burned, the depth of the burn and the location of the burn.

Before we dive into that, it’s important to understand that burns are just one type of severe alteration in skin integrity. We will also treat patients with massive skin injuries essentially the same. This includes patients with de-gloving injuries, Stevens-Johnsons syndrome, frostbite, TENS (toxic epidermal necrolysis syndrome) and even road rash.

Factor #1: The Type of Burn

Burns can be classified as electrical, radiation, chemical or thermal.

Electrical burns are caused by exposure to any electrical current, such as sticking a finger in the light socket (don’t do that!), touching a live power line or getting struck by lightning. Severity of the burn depends on the type of circuit, the voltage and amperage of the current, how long the exposure occurred, and the conductivity of the tissue. The damage with electrical burns is due to hyperthermia (excessive heat) as well as coagulation necrosis, so there’s more subdermal damage than with other types of burns.

When looking at the conductivity of the tissue, some are more electrically conductive than others. For example, bone is less conductive than muscles, blood vessels and nerves.

Children have the highest incidence of electrical burns either due to putting things in light sockets or chewing on cords. And, interestingly, lightning causes 80 deaths per year in the U.S., with the incidence seven times higher among men than women.

Radiation burns occur with exposure to UV light , radiation therapy or X-rays. The most common type of radiation burn is the sunburn, but also occurs frequently in patients undergoing cancer treatment. A key difference between radiation and thermal burns, is that the damage isn’t immediately apparent with radiation burns. In fact, it can take hours, days or even weeks before damage is noticed.

Chemical burns can occur when the skin comes into contact with a strong base or strong acid, or other caustic substances such as oven cleaner or even concrete mix. These are often related to workplace incidents, with eyes being the most commonly affected area.

It’s important to note that chemicals are not always liquids, but can also be airborne causing damage to the lungs, mouth and nose. Caustic chemicals can cause harm when touched or swallowed, so the damage can be extensive as well as internal. Additionally, chemicals that cause dermal burns can then be absorbed into the body causing systemic toxicity such as hydrofluoric acid which depletes the body of calcium and magnesium.

Not all chemical burns show immediate damage. Some may be delayed up to 48 hours before the full extent of the injury is known.

Thermal burns are those caused by exposure to heat. Most burns requiring medical treatment are due to thermal sources. Of these, the most common causes are flames and scalding liquids. Adults are more likely than children to be affected by flame injury, while children younger than age five are more likely to suffer from scald burns.

Additionally, when we think of thermal burns, we often think external damage, but the damage can be internal as well. Inhaling hot, smoke-filled air can damage the mouth, nose, airway and lungs.

Individuals most at risk for thermal burns are those with occupational hazards. A 2007 study showed that occupational burns were highest in those working in the accommodations and food services industry, followed next by manufacturing and then construction.

Factor #2: Burn Size

One of the key components of burn assessment is estimating the TBSA, the total body surface area that is affected by the burn. Essentially, treatment decisions are based on how much skin is injured, though the depth of the injury also comes into play. Two big factors it helps us determine are whether or not to treat (many burns do not require treatment, whereas others are so severe that palliative care is the only compassionate option) and how much fluid the patient will need. We’ll talk more about fluid resuscitation in another lesson.

We estimate TBSA by using a quick assessment tool called The Rule of Nine which divides the body into nine sections (ten if you count the genitals) which each represent either 9% or a multiple of 9%. This assessment will be done in the field, again in the ER and then again after the initial debridement, which will warrant the most accurate assessment.

Looking at the diagram here, you can see how the anatomic sections are divided into nine main sections

  • Entire head and neck = 9%
  • Chest = 9%
  • Abdomen = 9%
  • Upper back = 9%
  • Lower back = 9%
  • Entire left arm and hand = 9%
  • Entire right arm and hand = 9%
  • Entire right leg and foot = 18%
  • Entire left leg and foot = 18%
  • Genitals = 1%

When using the Rule of Nines to calculate TBSA, you have to take into consideration partial burns. For example, if the entire left arm is 9%, but only the front of the arm is burned, that’s 4.5%. Similarly, if the forearm is burned all the way around, that would be 4.5%. In addition, only partial and full-thickness burns are considered when calculating the TBSA and anything over 20% is considered a severe burn.

Let’s practice!

Using the Rule of Nines takes a little bit of practice, so let’s go through a few scenarios together. Scroll down below the references for the answers.

Scenario 1: Your patient is burned on his entire right arm and hand, front of left leg, chest, abdomen, and genitals. What is the TBSA that is burned?

Scenario 2: Your patient is burned on the abdomen, lower back and back of right leg. What is the TBSA?

Scenario 3: Your patient is burned on the front of both arms and hands, chest and abdomen. What is the TBSA?

Scenario 4: Your patient is burned on the front of his head/neck, chest and front of left arm. What is the TBSA?

A great online calculator is https://www.omnicalculator.com/health/parkland-formula

The Rule of Palm

Another way to estimate the size of a burn is the “rule of palm.” Utilizing this method, the palm of the patient (not counting the fingers or the wrist…just the palm) is equal to 1% of their body.

Factor #3 Burn Depth

Burns are classified by how deeply they penetrate the skin.

  • First-degree: Superficial burns that affect only the epidermis. There are no blisters, but the skin is red, painful and dry. Ex: mild sunburn
  • Second-degree: Partial thickness burns that extend partially into the dermal layer. The burn is blistered, red, painful and may be swollen. Partial thickness burns greater than 10% TBSA warrant burn center referral. Ex: burns from hot liquids
  • Third-degree: Full thickness burns that extend into the dermis and possibly extend into the subcutaneous tissue. May appear blackened, charred or even white; upon palpation the burned area may feel leathery and firm and does not blanch. Any full-thickness burn warrants burn center referral.
  • Fourth-degree: Full thickness burns that extend into the deeper tissues, affecting muscle and bone. Patients with fourth degree burns will have no pain or feeling in that area due to destruction of nerve endings.

Factor #4 The Burn Location

Another key factor in assessing the severity of a burn is where it is located. Some burns, due to their location, significantly impact patient outcomes. Because burns to the hands, feet, face, perineum and genitalia affect functional areas of the body, they require special therapies and are best treated at a designated burn center.

  • Head, neck and chest: For these burns I want you to be hyper vigilant and watchful for pulmonary complications. The airway could be burned, you could definitely have smoke and soot inhalation as well.
  • Circumferential burns of arms/legs can have a tourniquet-like effect, leading to vascular compromise distal to the injury.
  • Circumferential burns of the torso can lead to impaired chest wall expansion and severe pulmonary insufficiency.
  • Burns of hands and joints: Patients with these types of burns will usually require intensive PT/OT and can lead to permanent disability.
  • Facial burns: Consider the possibility of corneal abrasions and serious eye injury.
  • Perineal area burns: High risk for infection

Factor #5: Other Considerations

Other factors that will be taken into account when caring for patients with burns include:

  • Age – higher mortality for children under age 2 and adults over age 60
  • Associated injuries such as smoke inhalation and trauma
  • Medical conditions such as diabetes, renal impairment, and any cardiac or pulmonary dysfunction

References

Black, Joyce M., and Jane Hokanson Hawks. Medical-Surgical Nursing: Clinical Management for Positive Outcomes – Single Volume (Medical Surgical Nursing- 1 Vol (Black/Luckmann)). St. Louis: Saunders, 2009. Print.

Burn and Reconstructive Centers of America. (n.d.). Radiation burns. Burn and Reconstructive Centers of America. https://burncenters.com/burns/burn-services/radiation-burns/

Church, D., Elsayed, S., Reid, O., Winston, B., & Lindsay, R. (2006). Burn wound infections. Clinical Microbiology Reviews, 19(2), 403–434. https://doi.org/10.1128/CMR.19.2.403-434.2006

Deglin, Judith Hopfer, and April Hazard Vallerand. Davis’s Drug Guide for Nurses, with Resource Kit CD-ROM (Davis’s Drug Guide for Nurses). Philadelphia: F A Davis Co, 2009. Print.

Tbsa

Paradigm. (2013, August 1). Common Types of Burn Injuries and at Risk Occupations. Paradigm. https://www.paradigmcorp.com/insights/common-types-of-burn-injuries-and-at-risk-occupations/

Rice, N. A., & Greene, S. (2019, June 10). Don’t get burned by hydrofluoric acid toxicity. EMresident. http://www.emra.org/emresident/article/hydrofluoric-acid/

Sutherland, B. (2010, March). Care of the Burn Patient. Advanced Med/Surg. Lecture conducted from CSU Sacramento, Sacramento.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2010). Critical Care Nursing: Diagnosis and Management (Sixth). Mosby Elsevier.

ANSWERS TO TBSA PRACTICE QUESTIONS

Scenario 1: Your patient is burned on his entire right arm and hand, front of left leg, chest, abdomen, and genitals. What is the TBSA that is burned? 37%

    • Entire right arm = 9%
    • Front of left leg = 9%
    • Chest = 9%
    • Abdomen = 9%
    • Genitals = 1%
  • TBSA = 37%

Scenario 2: Your patient is burned on the abdomen, lower back and back of right leg. What is the TBSA?

    • Abdomen = 9%
    • Lower back = 9%
    • Back of right leg = 9%
  • TBSA = 27%

Scenario 3: Your patient is burned on the front of both arms and hands, chest and abdomen. What is the TBSA? 27%

Tbsa Burn Icd 10

    • Front of left arm = 4.5%
    • Front of right arm = 4.5%
    • Chest = 9%
    • Abdomen = 9%

Parkland Burn Formula

  • TBSA = 27%

Scenario 4: Your patient is burned on the front of his head/neck, chest and front of left arm. What is the TBSA?

Tbsa Burn Pediatrics

    • Front of head/neck = 4.5%
    • Chest = 9%
    • Front of left arm = 4.5%

Tbsa Burn Calculator

  • TBSA = 18%