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# Determining Depth & Percentage of Burn Injuries

There are many ways that you can be burned as well as there being more than one way to make an estimation in regard to the percentage of burn injury from thermal or chemical burns. This discussion reviews the depth of burn and the three methods for determining the extent of burn injury using percentages.

TCSS, Mike from Santa Barbara

First Degree Burn

Second Degree Burn

Third Degree Burn

The Rule of Nines

The rule of nines is an anatomical and graphical tool that divides the total body surface area (TBSA) into segments that are multiples of 9%.

The percentages used for each body part are different between adults and children.

This is the easiest method to use for adults and children older than 10yrs.

Child Rule of Nines Chart

Infant Rule of Nines Chart

Lund & Browder Chart

The Lund & Browder chart is considered the most accurate of all the methods as it assigns a specific number to each body part.

This method is most often used to measure burns in infants and young children because it allows for developmental changes in percentages of body surface area.

Lund & Browder Chart 5yrs - Adult:

Palm Method

The palm method is a tool whereby the size of the patients palm is used as an indicator for specific percentage of TBSA.

The surface area of a patients palm equals approximately 1% of TBSA.

This method is particularly useful where the burn has an irregular shape or has a scattered distribution.

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### Replies to This Discussion

Thanks alot Mike, thats very interesting, I never knew there were charts out there to determine this, I guess I thought the doctor had to tell you.
wow thats very interesting i have never seen a diagram of a burn % on people
We're taught the Rule of Nines here, and I've seen the Palm Method before. I've never heard of the Lund & Browder Chart though, interesting! Great post as usual Mike. Stay safe!
negative, it's up to us to make this call. I've provided these graphics for you to copy and put on a clipboard or something that you will have access to on a call. communicating with the burn center in regard to depth of burn, cause and percentage gets things rolling toward prepared patient care. all burns are bad but knowing what you are looking at and communicating that will make a big difference in how you are perceived and the level of professionalism you demonstrate...
I suppose I may post something on the difference between electical burns, chemical burns or thermal burns... As mentioned to TJ, now you can clearly communicate what you see...
Note: Added some additional graphics on the top of this page for reference to depth of burn. If you are powerpoint savy, either drag the graphics onto your desktop if you are a mac user or right click, save the photo if you are using a PC. Take these images and use them for developing your own in house ems training.
TCSS, Mike from Santa Barbara
Thanks Mike! We haven't covered burns yet in my EMT-B course but I'll definately be using this as a study reference. Super helpful - much appreciated!
I just lectured on this last week in Critical Care Paramedic, and the textbook we are using in the classroom, was actually using the theory of 4 degrees of burns.
Great info.....I have never heard of the Lund and Browder method. This is some great info that I will be sharing.

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