Question

Ms. Underwood is a 50-year-old female who has come to the local ED after suffering burns from a lawn mower accident. She has burn areas on the right side of her face and head; right shoulder, arm, and hand; and on the right side of her chest wall. She is alert and oriented to person, place, and time. Paramedics had started two IVs in her left arm and oxygen per nasal cannula.

1. How should this burn injury be classified? Is the local ED equipped to handle this patient?

The nurse in the ED is using the rule of nines to assess the Ms. Underwood's body surface area that is burned.

What is the Ms. Underwood's total body surface area that is burned? Why is this assessment important to Ms. Underwood's care?

Answer 1

Ms. Underwood's burns cover approximately 22.5% of her body, as estimated using the rule of nines. This assessment is crucial for guiding her treatment and determining the need for specialized care. The local ED's ability to handle her case depends on the burn classification, the TBSA affected, and the resources available.

Step-by-step explanation:

The burn injury sustained by Ms. Underwood is classified as a partial-thickness burn, considering the depth and extent of the burns on the right side of her face, head, shoulder, arm, hand, and chest wall. The local Emergency Department (ED) is generally equipped to handle this patient's initial assessment and stabilization, providing immediate care and preparing for potential transfer to a specialized burn center if necessary.

To determine the total body surface area (TBSA) burned using the rule of nines:

- The head and neck represent 9% of the total body surface area.

- Each upper extremity (arm) accounts for 9%.

- The chest area is 9%.

- The total surface area of the right side (head, shoulder, arm, and chest) affected by burns would be approximately 36%.

This assessment is crucial for several reasons:

1. **Treatment Planning:** The percentage of TBSA burned is crucial for estimating fluid resuscitation needs and determining the severity of the burn injury.

2. **Prognosis:** It helps predict potential complications and outcomes associated with burns.

3. **Specialized Care:** Establishes whether the patient requires transfer to a burn center for specialized treatment beyond the capabilities of the local ED.

4. **Monitoring:** Guides ongoing assessment and treatment, such as wound care, infection prevention, and pain management.

Assessing the TBSA burned aids in guiding immediate and long-term care for Ms. Underwood, ensuring appropriate interventions and management for optimal recovery.