The rule of 9s

[Lotus]

Can someone explain the rule of 9s please?

[Just Plain Ruff]

In a nutshell

Rule of 9s Each part of the body listed can be broken down to 9% of the body. Add up each part of the body burned and you get a rough percentage of how much of the body has been burned.

• ADULTS
  

• Head - 9%
  

• Arms - 9% each
  

• Legs - 18% each
  

• Chest - 18%
  

• Back - 18 %
  

• Groin - 1%
  

• CHILDREN
  

• Head - 18%
  

• Arms - 9% each
  

• Legs - 13.5 % each
  

• Chest - 18%
  

• Back - 18%
  

• Groin - 1%
  

[Cookie]

The rule of nines assesses the percentage of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit.

You can estimate the body surface area on an adult that has been burned by using multiples of 9.

An adult who has been burned, the percent of the body involved can be calculated as follows:

• Head = 9%
  
• Chest (front) = 9%
  
• Abdomen (front) = 9%
  
• Upper/mid/low back and buttocks = 18%
  
• Each arm = 9% (front = 4.5%, back = 4.5%)
  
• Groin = 1%
  
• Each leg = 18% total (front = 9%, back = 9%)
  

As an example, if both legs (18% x 2 = 36%), the groin (1%) and the front chest and abdomen were burned, this would involve 55% of the body.

[Just Plain Ruff]

I almost posted that one too Cookie. I find Google to be a great one of my friends at times.

[Cookie]

Yep google is my friend too, since I can't recall them off the top of my silver noggin anymore. I had a close encounter with a burn patient many years ago, and he survived despite my ministrations. Something I remind him to this day. He had 2nd and 3rd degree burns over 60 percent of his body. That call is the only one I can recall in perfect detail, right down to the smell, and I have never forgotten that smell.

[Just Plain Ruff]

I had a poor soul who didn't survive his brush with fire but I remember the call to this day. Head on collision, ruptured gas line, arrived to find fire trying to put out the car.

Fire chief said "you have two patients, one in the pickup bed, the other we're trying to put out".

the patient in the pickup bed, bad ankle fracture was her only injury. The guy in the car, basically his skin was melting off his bones.

2nd ambulance arrives, takes ankle lady to the hospital, we wait till they get the burned guy out, determine he's dead and clear the scene.

To this day,I can swear that there was absolutely no smell. No one on scene said that there was any burned body odor. It was a very surreal scene. Even pulling up to the scene the color of the flames was different than any other fire I've ever been to. Sort of an initial dark orange which then turned into a pale purplish blue.

Very very strange night.

Then we were dispatched to another fatal car accident which took the life of 4 teens who had all been drinking. Bad night for kids.

[DFIB]

Also,I know this isn't part of your question but for smaller burns you can look at the palm of the patients hand. Their palm size equals approximately 1% of their body size.

I hate seeing patients with large percentages of 2nd degree burns because of the great pain they have to endure..

[kreamer10]

One thing I would like to add is that. if I am not mistaken, you only calculate the part of the body that has partial or full thickness burns, superficial do not count when you are talking about the rule of 9's.

[Just Plain Ruff]

For long transport times, there is no way that ambulances carry enough pain meds to help these patients.

For ground transports of an hour or longer, what would be the feasibility of stopping off at a facility to medicate these patients and provide these patients with IV pain control such as pain pumps and such. With good communication such as call ahead, you could get a good enough report to the ER docs that they could get you orders for enough pain meds to provide pain control until you arrive at the receiving facility.

Had a meth lab flashover on a patient. She had burns on her hands, arms, face, chest, belly, legs, and feet. (quickly, figure the rule of 9's)

We had good airway support.

Hour long transport. Had 200mg of demerol in the ambulance, 20 of morphine. We had a relay system set up for the transfer from the scene to the next hospital to the next all the way to the receiving facility. I ended up deciding to tube her right before leaving the scene because of a single drop in pulse ox and the long transport time. I am sooooooooooo glad I did. 15 mins into the transfer her face swelled up like a balloon and I would have never got her tubed after that. I would have had to cric her..

We kept her well medicated with the narcs that were given to us at the first hospital we got to and then at the 2nd hospital there was a pharmacist who just happened to be in the hospital (this was at 330am) and he set us up with a Propofol drip and a dilaudid drip and he and a Nurse anesthetist from that hospital continued on with us to the burn unit.

It was a good outcome as the lady did great. She looked like the aftermath of a tracker Jacker sting victim but she survived.

Her boyfriend did the chivalrous thing, when the meth lab flashed over, he pussied out, pushed her into the path of the flames and ran the other way. A real piece of work.

[Lotus]

Thank you guys you're so much easier to understand then a textbook. What does cric mean by the way? I love your stories!