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Total body surface area (TBSA) is an assessment of injury to or disease of the skin, such as burns or psoriasis. In adults, the Wallace rule of nines can be used to determine the total percentage of area burned for each major section of the body.
To estimate the body surface area of a burn, the rule of nines assigns BSA values to each major body part: [3] This allows the emergency medical provider to obtain a quick estimate of how much body surface area is burned. For example, if a patient's entire back (18%) and entire left leg (18%) are burned, about 36% of the patient's BSA is affected.
The Lund and Browder chart is a tool useful in the management of burns for estimating the total body surface area affected. It was created by Dr. Charles Lund, Senior Surgeon at Boston City Hospital, and Dr. Newton Browder, based on their experiences in treating over 300 burn victims injured at the Cocoanut Grove fire in Boston in 1942.
The original Baux score was the addition of two factors, the first being the total body surface area affected by burning (usually estimated using the Wallace rule of nines, or calculated using a Lund and Browder chart) and the second being the age of the patient.
where mass (m) is in kilograms (kg), burned area (A) as a fraction of total body surface area, and volume (V) is in milliliters (mL). For example, a person weighing 75 kg with burns to 20% of his or her body surface area would require 4 x 75 x 20 = 6,000 mL of fluid replacement within 24 hours.
With a body temperature of 105 degrees (40.5 C) the woman was rushed to the hospital with second-degree burns on her back and right side, covering 8% of her body. She died three days later.
In large burns (over 30% of the total body surface area), there is a significant inflammatory response. [51] This results in increased leakage of fluid from the capillaries, [22] and subsequent tissue edema. [2] This causes overall blood volume loss, with the remaining blood suffering significant plasma loss, making the blood more concentrated. [2]
With a body temperature of 105 degrees (40.5 C) the woman was rushed to the hospital with second-degree burns on her back and right side, covering 8% of her body. She died three days later. Many surface burn patients also suffered potentially fatal heat stroke.