Pediatric emergency medicine trisk 3211 3211

significantly when 30% of TBSA is burned, and so those children should be
triaged to receive care more rapidly.
One possible triage guideline based on a five-level emergency severity
index (ESI) scale is shown in Table 104.1 .
Clinical Assessment
Percentages. After the primary survey and initial stabilization, a systematic
evaluation of the surface area and depth of burns follows. The rule of nines
is used to estimate burn surface area in adolescents and adults. Each arm is
approximately 9% TBSA, each leg is 18%, the anterior and posterior torsi
are each 18%, the head is 9%, and the perineum is 1%.
This rule cannot be applied to children because they have different body
proportions. In particular, young children have relatively larger heads and
smaller extremities. Therefore, age-adjusted methods of estimating burn
surface have been developed ( Fig. 104.1 ). Alternatively, a child’s palm
including the fingers is approximately 1% of BSA and this can be used to
estimate the extent of scattered, smaller burns.