What is the estimated TBSA in a 65 kg male with first and second degree burns on the face, bilateral arms up to the elbow, and the left leg up to the knee, and no known pre-existing medical conditions?

TBSA Calculation for This Burn Patient

The estimated total body surface area (TBSA) burned in this 65 kg male is 27.5% using the Rule of Nines for adults. 1

Anatomical Breakdown Using Rule of Nines

The Rule of Nines is the standard method recommended by the American Burn Association for calculating TBSA in adults 1. Here's the calculation for each burned area:

Face

• Face = 4.5% TBSA (anterior head is 4.5% of the 9% allocated to entire head) 1

Both Arms to Elbow (Anterior and Posterior)

• Each entire arm = 9% TBSA 1
• Arm from shoulder to elbow = approximately 4.5% per arm (half of the full arm)
• Both arms anteriorly and posteriorly to elbow = 4.5% × 2 arms = 9% TBSA

Left Leg to Knee (Anterior and Posterior)

• Each entire leg = 18% TBSA 1
• Leg from hip to knee = approximately 9% per leg (half of the full leg)
• Left leg anteriorly and posteriorly to knee = 9% TBSA

Additional Considerations for Partial Limb Burns

• Upper arm (shoulder to elbow) represents approximately 4.5% per arm when both anterior and posterior surfaces are involved
• Thigh (hip to knee) represents approximately 9% per leg when both anterior and posterior surfaces are involved

Total TBSA Calculation

Face (4.5%) + Both arms to elbow (9%) + Left leg to knee (9%) = 27.5% TBSA 1

Clinical Implications

This patient requires immediate transfer to a specialized burn center because burns >10% TBSA in adults mandate specialized care 1, 2. The American Burn Association emphasizes that specialist management significantly improves survival and reduces complications 2.

Immediate Management Priorities

• Initiate aggressive fluid resuscitation immediately using the Parkland formula: 2-4 mL/kg/%TBSA of balanced crystalloid solution 1, 2

  • For this 65 kg patient with 27.5% TBSA: 3,575-7,150 mL over 24 hours
  • Give half in the first 8 hours post-burn 1

• Target urine output of 0.5-1 mL/kg/hour (32.5-65 mL/hour for this patient) to guide ongoing fluid administration 1, 2

• Contact a burn specialist immediately to arrange direct transfer, as every hour matters for survival 2, 3

• Continue fluid resuscitation during transfer, titrating to urine output 2

Critical Pitfalls to Avoid

• Do not delay transfer while attempting wound care—resuscitation takes priority and definitive care requires burn center expertise 2, 3
• Avoid "fluid creep" by titrating fluids strictly to urine output rather than blindly following formulas 2
• Do not use ice directly on burns, as hypothermia risk is significant with this TBSA 3