Emergency Medicine

BURNS

Surgical Emergencies 251

5 Check for associated injuries, particularly if burns occurred from an explo-

sion, blast injury or high-voltage electrocution.

6 Determine the extent of the burn.

(i) Use Wallace’s Rule of Nines in adults, ignoring areas of mere

erythema (see Fig. 8.2).

(ii) Use comparison with the size of the child’s palm, equal to 1% of

body surface area (BSA), when estimating the extent of a burn

in children. A child’s head is relatively larger than an adult’s

(12–14%) and the legs are relatively smaller (14%).

(iii) Or use a body map such as a Lund and Browder chart.

Figure 8.2 Wallace’s Rule of Nines in adults, for estimating the percentage of body
surface area burned

9%

9% 9%

1%

18% 18%

Front 18%

Back 18%