58.3 What percentage of a patient’s body surface has been burnt?

The proportions of parts of the body differ in adults and children. Estimate them with the chart in Fig. 58-4, which is also included as a ’tear out page’ at the end of the book. This table is difficult to remember, so memorize the rule of nines in adults and the rule of sevens in children, in Fig. 58-3. Remember that the area of a patient’s hand (not yours!) is about 1% of the total area of his body. When you calculate the area of a burn, don’t include the area of erythema in a white skin (it is not visible in a black one). Blisters may not appear for 24 hours, so revise your estimate if more appear after you have first examined a patient. Burns are easily underestimated in a black skin, and over-estimated in a white one.

There is an upper limit to the severity of a burn above which a patient is almost sure to die, and if he does live his life will only be a burden to him. In anything but the most sophisticated burns units a patient with a burn of 60% or more is so unlikely to live that compassionate palliation may be the only logical treatment for him. Morphine and a drip to prevent him suffering thirst will make his last days more comfortable. Scarce facilities are probably better kept for patients with a greater chance of life.