Burn Size

The size of a burn injury is quantified as the percentage of body surface area (BSA) involved. 7 One method of calculating the percentage of BSA burned is to use the rule of nines (Fig 194-1). This method divides the body into segments that are approximately 9 percent or multiples of 9 percent, with the perineum forming the remaining 1 percent. In infants and children, this method must be modified because of their larger heads and smaller legs.

FIG. 194-1. Rule of nines to estimate percentage of burn.

Another method is based on the fact that the area of the back of a patient's hand is approximately 1 percent BSA. The number of "hands" that equal the area of the burn can approximate the percentage of BSA burned.

A more precise estimation of the percentage of BSA burned is obtained by using a Lund and Browder burn diagram ( Fig 194-2). This allows for accurate determination of the size and depth. These charts are age-adjusted, hence allowing for changes in children at different ages.

FIG. 194-2. Lund and Browder diagram to estimate percentage of pediatric burn.

Experienced burn-care nurses and physicians are reliable in estimating burn size regardless of the method used. 8 However, it is common for inexperienced individuals to estimate burn size incorrectly when patients are first assessed in the ED.

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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