## Medical Surgical Critical Care Burns #1

### Question

A client comes into the Emergency Department (ED) with full-thickness electrical burns covering the hands, arms, and frontal trunk. According to the Rule of 9’s, what is the client’s total body surface area (TBSA)?

### Answers

1. 18% TBSA
• Rationale:

This answer is not correct because the burn covers the hands, arms, and frontal trunk, the total percentage burned is 36%. Each hand and arm are 9%, so since both hands and arms were included, that is a total of 18%, and the frontal or anterior trunk is 18%. 18% + 18% = 36% total body surface area burned.

2. 25% TBSA
• Rationale:

This answer is not correct because the burn covers the hands, arms, and frontal trunk, the total percentage burned is 36%. Each hand and arm are 9%, so since both hands and arms were included, that is a total of 18%, and the frontal or anterior trunk is 18%. 18% + 18% = 36% total body surface area burned.

3. 30% TBSA
• Rationale:

This answer is not correct because the burn covers the hands, arms, and frontal trunk, the total percentage burned is 36%. Each hand and arm are 9%, so since both hands and arms were included, that is a total of 18%, and the frontal or anterior trunk is 18%. 18% + 18% = 36% total body surface area burned.

4. 36% TBSA
• Rationale:

This answer is correct because the burn covers the hands, arms, and frontal trunk, the total percentage burned is 36%. Each hand and arm are 9%, so since both hands and arms were included, that is a total of 18%, and the frontal or anterior trunk is 18%. 18% + 18% = 36% total body surface area burned.

### Overview

The rule of 9’s divides the body into percentages. The total body surface area (TBSA) is how much of the total body was burned.

### Learning Outcomes

The rule of 9’s divides the body into percentages. Each arm including each hand is 9% each; the anterior trunk is 18%; posterior trunk is 18%; the head and neck are 9%, perineum or genitalia is only 1%; and legs with the feet are 18% each. The total body surface area (TBSA) is how much of the total body was burned. A full-thickness burn penetrates all the skin layers, which include the epidermis, the dermis, through the subcutaneous layer, muscle, and even bone.

### Test Taking Tip

Know the “Rule of 9’s” to determine the total body surface area (TBSA) for burns. These will be on NCLEX.