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In adults, each upper extremity and the head and neck are 9% of the total body surface area (TBSA), the lower extremities and the anterior and posterior trunk are 18% each, and the perineum and genitalia are assumed to be 1% of the TBSA.
Another method of estimating smaller burns is to equate the area of the open hand (including the palm and the extended fingers) of the patient to be approximately 1% TBSA and then to transpose that measurement visually onto
Infants have 21% of the TBSA in the head and neck and 13% in each leg, which incrementally approaches the adult proportions with increasing age. fte Berkow formula is used to accurately determine burn size in children (Table 19-1).
Severe burns covering more than 20% TBSA in adults and 40% TBSA in pediatric patients are typically followed by a period of stress, inflammation, and hypermetabolism, characterized by a hyperdynamic circulatory response with increased body tempera- ture, glycolysis, proteolysis, lipolysis, and futile substrate cycling (Fig. 19-4). ftese responses are present in all trauma, surgical, and critically ill patients, but the severity, length, and magnitude are unique for burn patients.5
The yellow bars represent patients with burns <40% total body surface area (TBSA).
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