Burns: Rule of Nines

Complete Clinical Textbook for Emergency Medicine, Surgery, ICU & Nursing Practice

1. Introduction

Burn injuries are severe systemic trauma conditions affecting skin integrity, fluid balance, thermoregulation, immunity, and metabolic function. Severe burns are managed as a multi-organ disease process, not just a skin injury.

📌 TBSA + depth determine severity, management, and prognosis.

2. Causes (Etiology)

• Thermal burns (flame, scald, contact)
• Chemical burns (acids, alkalis)
• Electrical burns
• Radiation burns

3. Pathophysiology (Interactive)

Cellular Injury

Vascular Leak

Inflammation

Metabolism

4. Classification of Burns

• 1st degree: Epidermis only, erythema, pain
• 2nd degree: Partial thickness, blistering, severe pain
• 3rd degree: Full thickness, painless, leathery skin
• 4th degree: Muscle/bone involvement

⚠ Full-thickness burns may be painless due to nerve destruction.

5. Rule of Nines

Head

Arms

Trunk

Legs

6. Medical Management

Emergency Phase (0–24h):
• Airway protection (early intubation if inhalation injury)
• High-flow oxygen
• IV fluid resuscitation (Parkland formula)
• Pain control (opioids)
• Prevent hypothermia

Acute Phase (24h–72h):
• Wound cleaning and debridement
• Infection control
• Nutritional support
• Electrolyte monitoring

Recovery Phase:
• Skin grafting
• Physiotherapy
• Scar management

7. Nursing Management

• Airway monitoring and oxygen therapy
• Fluid balance charting (urine output ≥0.5 ml/kg/hr)
• Wound care and sterile dressing changes
• Pain assessment and opioid administration
• Infection prevention (aseptic technique)
• Psychological support

8. Parkland Formula

TBSA (%) Weight (kg)

Awaiting input...

9. Complications

Early: Shock, airway obstruction, ARDS
Late: Sepsis, renal failure, contractures, hypertrophic scars

10. Prognosis

Depends on age, TBSA, inhalation injury, and comorbidities. Mortality increases significantly when TBSA >40%.

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