this is cereth registered nurse ari and calm and in this video i want to be going over the rule of nines for burns in an adult patient in this video is part of an in quick series that i'm going to be covering over burns and as always don't forget to take the free quiz that will test you on how to calculate the rule of nines so let's get started what is the rule of nines the rule of nines is a calculation used to calculate the total body surface area percentage of the body that is burned and we use this calculation for adults now why would we care about knowing the percentage of the total body surface area that's burned on the body well for a couple reasons number one does this patient meet criteria to go to a burn unit also those first 24 hours after severe burns there the patient is at risk for hypovolemic shock and what happens with severe burns is that it increases the capillary permeability so what happens is that you have your fluid that's normally in your intravascular system it's going to leave and go into the interstitial tissue well what does that leave in the intravascular system for the heart to pump to your vital organs and tissues hardly anything at all so the patient is at risk for death and during those first 24 hours we need to replace their fluids and we take the total body surface percentage and we plug that into what's called a Parkland burn formula which we're going to talk about in the next video and this will help us determine how much fluid replacement that patient needs during the next 24 hours and the most common solution you use to treat burns during the first 24 hours is lactated ringers now let's talk about how to calculate the rule of nines and then I want to work a practice problem of something similar you won't counter on an exam okay so whenever you're doing this you want to keep some things in mind you want to keep in mind the anterior part of the body which is the front and the posterior part of the body which is the back because a lot of times people forget that oh it said the head in the neck anterior and posterior I need to add these two numbers together so they leave that out and they get their calculation wrong now each area is going to be divided into the like the head and neck the trunk the arms upper extremity the perineum and then the lower extremities which are the legs and each area is assigned a product of nine which makes it a little bit easier to remember so let's go over this okay I like to start from head to toe makes it easier we have the head and the neck the front part of the head and neck the interior part is 4.5% that's how much that's worth the back the posterior part is also 4.5% and if you add those up together say the patient had burns on the front of the head the neck and the back of the head and neck that would equal total of nine percent then we're going to move down to the trunk okay the anterior part of the trunk the front is worth 18% and then the back of the trunk is worth 18% so if you have burns on both the anterior and posterior part of the trunk that would be 36% then we have our upper extremities our right arm and our left arm okay front of the right arm is worth 4.5% front of the left arm is worth 4.5% and that together would equal nine so on the front over here that would be 9% if you had the front of both arms burned so we'll hit anterior arms then we flip the patient over if they have burns on their right back in the arm it's 4.5% in the back of their left arm it's 4.5% add those together you get nine so nine percent on that the posterior arms but when you add them together so your patient had burns on both the front of the arm both arms in the back of both arms that would equal total of eighteen percent so see why I said remember that you have two of each and don't leave one out because it's easy to do that then we move down to the front right here that's a para name by it is worth 1% and then we have our lower extremities or legs and again don't forget that you have two of those and you have the posterior in the anterior so the right leg is worth nine the front and the left leg is worth nine the front so I got together you get 18 percent then the back the right leg is worth 9 the left leg is worth 9 so you get 18 percent again that's the posterior part of the legs and then when you add if your patient had burns on both the front and the back of both legs that would be 36% so when you add 9 + 36 + 18 + 1 + 36 that gives you a hundred percent so now let's look at a practice problem our problem says a 35 year old female has deep partial thickness burns on the front and back of both arms anterior trunk back of left leg anterior and posterior sides of the right leg posterior head and neck and perineum what is the total body surface area percentage that is burned so now let's calculate okay our patient has burns on the front in the back of both arms so each arm in the front is each worth 4.5% which would be a total of nine and then we flip the patient back each arm again is worth four point five percent they equals nine nine plus nine equals eighteen percent Nina says anterior trunk so that's the front and the front is worth 18% Nina says the back of the left leg that is worth nine percent then it says anterior and posterior right leg so we're going about the front and the back of the right leg so the front of the right leg is worth nine the back of the right leg is worth nine so that equals eighteen percent then this has the posterior part of the head and necks of the back of the head and neck and that is 4.5% and then the perineum it's 1% so then all we do is add all that up and what do we get we get sixty eight point five percent is our total body surface area percentage that is burned on this patient okay so that wraps up this review on how to calculate the rule of nines for burns thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos