The "rule of palms" in burns is a method used to quickly estimate the total body surface area (TBSA) affected by the burn.
Understanding the Rule of Palms
The rule states that the palm of the patient (excluding fingers and wrist) represents approximately 1% of their total body surface area.
How to Apply the Palm Rule
- Use the Patient's Palm: It's crucial to use the patient's palm, as palm size varies from person to person.
- Estimate Coverage: Visualize how many times the patient's palm would fit over the burned area.
- Calculate Percentage: Each palm-sized area equates to approximately 1% TBSA. For example, if the burn covers an area about the size of 5 palms, the estimated TBSA burned is 5%.
When to Use the Palm Rule
The rule of palms is especially useful for:
- Estimating small or scattered burns: When burns are irregularly shaped or cover only small portions of the body, the rule of palms offers a more practical estimate than the rule of nines (which is better suited for larger, more confluent burns).
- Quick initial assessment: It allows for a fast approximation of burn size in emergency situations, aiding in initial triage and fluid resuscitation decisions.
- Supplementing other methods: It can be used in conjunction with other estimation methods, such as the Rule of Nines, to improve accuracy.
Limitations
While useful, the rule of palms has limitations:
- Accuracy diminishes with larger burns: For burns covering a significant portion of the body (e.g., >15-20% TBSA), the Rule of Nines generally provides a more accurate estimate.
- Variability in hand size: Although the palm represents approximately 1% TBSA for most adults, variations in hand size can affect the precision of the estimate.
- Not applicable to children: For children, burn surface area estimation charts that take age into consideration provide more accurate results.
In summary, the rule of palms provides a rapid and practical way to estimate the percentage of total body surface area affected by a burn, particularly useful for smaller or scattered burns.
