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Determining Total Body Surface Area

Wallace Rule of Nines and Palmar Method

PDF version for print: Determining Total Body Surface Area (PDF)
Courtesy of the American Burn Association.

Rule of Nines Adults (Age ≥ 14 years)

Rule of Nine for Adults: Anterior side of body: Head and neck 9% Upper Thorax 9% Lower Thorax 9% Right Leg 9% Left Leg 9% Right Arm 4.5% Left Arm 4.5% Perineum 1% Poster side of body: Head and neck 9% Upper Thorax 9% Lower Thorax 9% Right Leg 9% Left Leg 9% Right Arm 4.5% Left Arm 4.5%

Role of Nines for Children (Age 1-14 years)

Rule of Nines for children (1-14): Child ages 1-4: Head 19% Each Arm 9.5% Thorax 32% Each Leg 15% Child ages 5-9: Head 15% Each Arm 9.5% Thorax 32% Each Leg 17% Child ages 10-14 Head 13% Each Arm 9.5% Thorax 32% Each Leg 18%

Rule of Nines for Infant (Age < 1 year)

Rule of Nine for Infant: Head and Neck 21% Each Arm 10% Abdomen 13% Each Leg 13.5% Genital Area 1% Back 13% Buttocks 5%

Palmar Method

mage of palm to represent using the palm of burn victim to estimate total body surface area. Palm of patient is approximately 1% of surface area

Estimate with fingers positioned together as above. Utilize the patient's palm size not your own.

The Palmar Method of estimating total body surface area (TBSA) is an easy way to get a rough burn size estimate that can be used when calculating a patients fluid resuscitation needs.

The patient’s palmar surface including their fingers = 1% TBSA

Courtesy of the American Burn Association.