Wallace rule of nines

Wallace Rule of Nines is a tool used in the medical field, particularly in the areas of burns and emergency medicine, to estimate the total body surface area (TBSA) affected by a burn. This method is crucial for assessing the severity of burns and determining the appropriate treatment plan, including fluid resuscitation. The rule divides the body into sections that represent 9% or multiples of 9% of the body surface area, making it easier for healthcare professionals to quickly estimate the extent of burns.

Overview

The Wallace Rule of Nines is applied by dividing the adult human body into sections that are approximately 9% of the total body surface area. The body is divided as follows:

• The head and neck account for 9% of the body's surface area.
• Each arm also represents 9%.
• The front and back of the torso each account for 18% (9%+9%).
• Each leg accounts for 18% (9%+9%).
• The genital area (perineum) is considered to represent 1% of the body's surface area.

For children and infants, the percentage of the head and neck is greater, and the percentage of the legs is less than in adults. This difference is often adjusted in pediatric assessments by using modified charts or the Lund and Browder chart, which is considered more accurate for children.

Application

The Wallace Rule of Nines is primarily used in the initial assessment of burn victims to estimate the extent of burns. This estimation is critical for determining the need for fluid resuscitation, calculating caloric needs, and planning for potential transfer to specialized burn units. The rule is a quick method that can be used in emergency settings but should be followed by more precise methods when possible.

Limitations

While the Wallace Rule of Nines is a valuable tool in the initial assessment of burn victims, it has limitations. The rule is less accurate for patients with significant deviations in body composition, such as obesity or cachexia, and in the case of irregular burn patterns. In such cases, more detailed assessments, including the use of the Lund and Browder chart or digital imaging techniques, may be required for accurate estimation.

Conclusion

The Wallace Rule of Nines remains a fundamental tool in the management of burn injuries, providing a quick and simple method for estimating the extent of burns. However, healthcare professionals should be aware of its limitations and consider more precise methods when necessary for accurate assessment and treatment planning.

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