Rule of Palm

Use our Rule of Palm template for quick and accurate burn size estimation, an essential tool for effective burn management and patient education.

By Nate Lacson on Jul 15, 2024.


Fact Checked by Wynona Jugueta.

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Types of burns

Burn injuries are among the most painful and complex injuries treated in medical practice. They occur when tissues are exposed to thermal, chemical, electrical, or radiation sources. Understanding the various types of burns is essential for effective treatment and management.

Thermal burns

Thermal burns are caused by exposure to heat sources like fire, steam, hot liquids, and other high-temperature materials. These burns can range from mild, superficial burns to deep, full-thickness injuries depending on the temperature and duration of exposure.

Radiation burns

Radiation burns result from exposure to ultraviolet rays or other radiation sources, including sunlight, tanning booths, and medical radiation treatments. These burns can damage the skin and deeper tissues, and often require specialized treatment to manage both immediate and long-term effects.

Chemical burns

Chemical burns occur when skin or eyes come into contact with an irritant or corrosive substance such as acids, alkalis, or detergents. The severity of chemical burns depends on the nature of the chemical, the amount, and the duration of contact, requiring immediate decontamination and treatment to prevent deeper tissue damage.

Electrical burns

Electrical burns happen when electric current passes through the body, potentially causing severe internal and external injuries. These burns are particularly dangerous because they can affect the underlying tissues and organs, even if surface damage appears minimal.

How to classify burns

Burns can be caused by different things, and they vary based on depth and severity. Classifying burns by their depth helps guide treatment decisions and provides a prognosis. This classification is critical for healthcare professionals as it determines the necessary care and management strategies.

Superficial (first degree)

Superficial burns affect only the outermost layer of the skin, the epidermis. These are characterized by redness, non-blistered skin, and mild pain and are synonymous with first-degree burns. They usually heal within a week without long-term scarring.

Superficial partial-thickness (second degree)

Superficial partial-thickness burns affect both the epidermis and the upper layers of the dermis. They cause swelling, redness, and blistering, and are extremely painful. These burns are often referred to as second-degree burns and may require several weeks to heal, with potential for minimal scarring.

Deep partial-thickness (second degree)

Deep partial-thickness burns extend deeper into the dermis and may appear white or less red than superficial burns. They can destroy nerve endings, making them less painful. Also classified under second-degree burns, these injuries might need skin grafting as they heal and can result in significant scarring.

Full thickness (third degree)

Full thickness burns penetrate the entire dermis and affect deeper tissues, potentially damaging muscle, fat, and bone. The burn site may appear white, charred, or leathery. These are known as third-degree burns and almost always require surgical treatment such as skin grafts and can result in severe scarring and loss of function.

Importance of estimating burn size

Estimating the size of a burn is crucial in the clinical management of burn injuries. The extent of skin surface area affected by burns directly influences treatment decisions, fluid resuscitation strategies, and the need for specialized burn care facilities.

Accurately determining the size of the burn helps medical professionals assess the severity of the injury and predict potential complications such as infection, dehydration, and shock. Larger burns covering significant portions of the body surface area (TBSA) may require immediate and intensive treatment, including intravenous fluids, nutritional support, and possibly surgery.

Moreover, understanding the percentage of TBSA burned is essential for calculating fluid requirements during the initial resuscitation phase following major burns. This calculation is vital to prevent under or over-resuscitation, both of which can have profound impacts on the patient’s recovery and overall prognosis.

Different ways to estimate burn size

Accurately estimating the size of a burn is critical for effective management and treatment. Several methods are commonly used in clinical settings to determine the total body surface area (TBSA) affected by burns.

Lund and Browder Chart

The Lund and Browder chart is a detailed tool that adjusts for the age and growth of the patient, providing more accurate estimations of TBSA affected by burns. It differs from other methods because it accounts for the proportional differences in body parts with age, making it especially useful in pediatric burn cases.

Rule of nines

The Rule of Nines is a quick and easy method used primarily for adults, dividing the body into sections that represent 9% (or multiples thereof) of the body surface area. It is particularly effective for initial assessment in emergency settings, allowing rapid calculations to facilitate urgent care decisions.

Rule of Palm

The Rule of Palm estimates the size of a burn by comparing it to the size of the patient's palm, which approximately constitutes 1% of the TBSA. This method is highly practical and can be used directly at the bedside or in the field, providing a quick visual assessment that helps guide the initial management of burn injuries.

Each of these methods has its advantages and can be chosen based on the specific circumstances of the assessment, such as the patient's age, the environment (pre-hospital or in-hospital), and the need for quick versus more detailed estimation.

Let's discuss the Rule of Palm in more depth in the following section.

What is the Rule of Palm?

The Rule of Palm is a straightforward and widely utilized method for estimating the size of a burn injury. It involves using the patient's palm, including the fingers, as a reference, which approximately accounts for 1% of the total body surface area (TBSA). This method is quick, easily accessible, and does not require complex tools, making it especially useful in emergency situations and initial assessments.

The Rule of Palm offers several advantages. First, it does not need any special equipment, allowing healthcare providers to rapidly estimate burn size. It's easy enough for anyone to do, including those with minimal training in burn care. And lastly, it can be applied to patients of all ages, although adjustments may be needed based on the relative size of the patient’s hand to their body.

However, the Rule of Palm is not without drawbacks. While it provides a quick estimate, it may not always offer the precision required for extensive burns or when a detailed assessment is necessary for ongoing care. In such cases, more accurate methods like the Lund and Browder chart or the Rule of Nines are preferable.

How does our Rule of Palm template work?

Our Rule of Palm template is designed as a quick-reference handout that healthcare professionals can use to educate staff and patients about estimating burn size accurately. It shows an easy-to-understand diagram of the Rule of Palm for both infants and adults.

Here's how to implement this template effectively in your practice:

Step 1: Access this template

Healthcare professionals can access this template digitally through the Carepatron app and the Carepatron website's template library, available for immediate use on any device. It is also downloadable and printable, allowing for use in environments where digital access may be limited. You can also customize it to show your healthcare practice's name and insignia.

Step 2: Explain the template

Before using the template, you can quickly explain its contents to team members who will use it or to patients who will receive the handout. This includes discussing how the Rule of Palm is used to quickly estimate burn size and the significance of accurate measurement in managing burn injuries. Ensuring everyone understands the method’s application and importance aids in achieving accurate assessments.

Step 3: Display or distribute the handout

Once customized and explain, display the template prominently in common areas, treatment rooms, or training halls, or hand it to patients for quick reference. It serves as an educational tool for new staff and a quick-reference guide for experienced personnel. For patient education, it can be displayed in waiting areas or consultation rooms to help patients understand the assessment of burn sizes, or they can pin them up at home or workplace, especially if their workplace has many burn hazards.

Benefits of using our template

Using the Rule of Palm template in healthcare and high-risk work environments offers distinct advantages. Here are the streamlined benefits of incorporating this template into your practice:

  • Streamlines education: Simplifies burn size estimation training for staff and educates patients efficiently, ensuring crucial information is easily understood and remembered.
  • Enhances consistency: Standardizes the approach across teams, reducing errors and enhancing the accuracy of burn assessments for better outcomes.
  • Improves patient communication: Facilitates clearer explanations to patients about burn size estimation, increasing their understanding and easing anxiety.
  • Saves time: Offers a quick reference that speeds up both training and clinical assessments without sacrificing accuracy.
  • Facilitates compliance and documentation: Provides a consistent framework for documenting burn assessments, aiding in accurate medical record keeping and regulatory compliance.
  • Ideal for high-risk environments: Acts as a crucial quick reference in workplaces with burn hazards, enabling swift assessment and initial response, which can mitigate injury severity.

These benefits highlight the template’s role in improving operational efficiency, patient care, and safety protocols, making it a valuable tool for healthcare professionals and safety managers alike.

What is the rule of palms for TBSA?
What is the rule of palms for TBSA?

Commonly asked questions

What is the rule of palms for TBSA?

The rule of palms is a method used to estimate the size of a burn injury, where the patient's palm (including fingers) represents approximately 1% of their total body surface area (TBSA).

What are the 6 Cs of burns?

The 6 Cs of burn care include: Clothing, removing any non-adhered clothing around the burn; Cooling, applying cool water for 20 minutes to reduce pain and swelling; and Cleaning, using mild soap and water. Chemoprophylaxis involves applying antimicrobial agents to prevent infection, Covering uses a sterile dressing to promote healing, and Comforting entails providing pain relief and support to manage discomfort and anxiety.

What is the golden rule of burns?

The golden rule of burns is to cool the burn with running water for at least 20 minutes, remove all clothing and jewelry from the area, and cover the burn with a clean, dry cloth.

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