What percentage of the body surface area is affected by a burn on the right upper limb of a 17-year-old patient?

Burn Surface Area Calculation for Right Upper Limb in a 17-Year-Old

The right upper limb represents 9% of the total body surface area (TBSA) in a 17-year-old patient.

Burn Surface Area Assessment Methods

• The most accurate method for determining burn surface area is the Lund-Browder chart, which accounts for age-specific body proportions 1
• For quick estimation in the field, the "Rule of Nines" is commonly used, where the entire upper limb represents 9% of TBSA 2
• Alternative methods include using the patient's palm (including fingers) which approximates 1% of TBSA as a reference point 3, 4

Age-Specific Considerations

• In a 17-year-old patient, body proportions are essentially the same as an adult, so adult burn assessment charts apply 3
• The right upper limb (entire arm including hand) represents 9% of TBSA in adults and older adolescents 2
• This differs from younger children, where limbs represent a smaller percentage of TBSA due to different body proportions 1

Clinical Implications

• Accurate TBSA assessment is crucial for determining:

  • Need for specialized burn care (adults with burns >10% TBSA should receive specialized care) 5
  • Fluid resuscitation requirements (using formulas like the Parkland formula) 3
  • Mortality risk assessment (larger TBSA burns correlate with increased mortality) 6

• For a 17-year-old with a burn to the entire right upper limb:

  • This represents a significant burn (9% TBSA) 2
  • Would require consideration for transfer to a burn center 5
  • Would need careful monitoring for signs of hypovolemic shock 3

Common Pitfalls in Burn Assessment

• Overestimation of burn size is common in emergency departments, occurring in 70-94% of cases 3
• Inaccurate estimations are particularly common in pediatric patients and with very small or very large burns 1
• Using standardized tools like burn cards can improve accuracy of assessment 4
• Failure to accurately assess burn size can lead to inappropriate fluid resuscitation and treatment decisions 1

Conclusion for This Case

• For this 17-year-old patient with a burn to the entire right upper limb, the correct TBSA is 9% 2
• This is significant enough to warrant careful monitoring and consideration of specialized burn care 5
• The 18% option would be an overestimation (would represent both upper limbs)
• The 4.5% option would be an underestimation (would represent approximately half of one upper limb) 2