Advanced Trauma Life Support ATLS Student Course Manual 2018

PATIENT ASSESSMENT 175
History
The injury history is extremely valuable when treating
patients with burns. Burn survivors can sustain
associated injuries while attempting to escape a fire,
and explosions can result in internal injuries (e.g.,
central nervous system, myocardial, pulmonary, and
abdominal injuries) and fractures. It is essential to
establish the time of the burn injury. Burns sustained
within an enclosed space suggest the potential for
inhalation injury and anoxic brain injury when there
is an associated loss of consciousness.
The history, whether obtained from the patient or
other individuals, should include a brief survey of
preexisting illnesses and drug therapy, as well as any
known allergies and/or drug sensitivities. Check the
status of the patient’s tetanus immunization. Be aware
that some individuals attempt suicide through selfimmolation.
Match the patient history to the burn
pattern; if the account of the injury is suspicious,
consider the possibility of abuse in both children
and adults.
Body Surface Area
The rule of nines is a practical guide for determining the
extent of a burn using calculations based on areas of
partial- and full-thickness burns (n FIGURE 9-4). The adult
body configuration is divided into anatomic regions
Pediatric
9%
9%
4.5%
13%
4.5%
4.5%
18%
4.5%
2.5%
2.5%
7% 7%
7%
7%
Adult
4.5%
4.5%
n FIGURE 9-4 Rule of Nines. This practical guide
is used to evaluate the severity of burns and
determine fluid management. The adult body is
generally divided into surface areas of 9% each
and/or fractions or multiples of 9%.
18%
4.5%
4.5%
18%
4.5% 4.5%
1%
9% 9% 9% 9%
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American College of Surgeons
Figure# 09.01