Rule of 7 burns child. 3 Rule of nines’ for adults and children. ​

Systemic response. For children, the head, thigh, and leg percentages vary with age and are designated as A, B, and C, respectively. g. Burns that exceed 20% of TBSA according to the Rule of Nines produces a systemic response. 5 3. In pediatric patients, this can be calculated using the Rule of Nines for children: 9% for each arm, 14% for each leg, When measuring burns in adults, the rule of nines assesses the percentage of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit. May 1, 2022 · The burn site looks red, blistered, and may be swollen and painful. Inhalation injury 7. Get access to exceptional clinical services close to where you live, work, and even on your phone. 1,3 Although potentially life Spanish: Para traducir este sitio web, debe actualizar su navegador a la última versión de Microsoft Edge. about 1% TBSA. most burns in children are the result of child abuse c. Quickly assess the severity of burns by entering the percentage of burns on each body part. 0 4. " This method divides a baby's body surface area into percentages. Moreover, an Mar 9, 2017 · Burn injuries are considered the fifth most common cause of non-fatal childhood injury worldwide. Rule of Nines for burns on children: The entire surface of the body is divided into 7 areas, with these percentages: Children comprise 29% of all burn victims. 8-year-old with an inhalation injury B. pediatric patients are more prone to hyperthermia d. Estimate with fingers positioned together as above. 2 The majority of admissions result from scalds, followed by contact and flame burns. Nov 29, 2019 · The assessor draws an outline of the burn wound on the anterior and posterior body diagrams, calculates the burn area in each region, and then sums the area to obtain the body percentage of the burn wound. 9 m 2, 1. The calculator will help you determine whether the burns are mild, moderate, or severe based on the rule of nines standards. Available medizinischer learning, class and course book add. Rule of nines (9s) burn chart PDF. 05. Use the rule of 10’s to start. Each Posterior Arm: In children, each posterior arm region covers approximately 6. Rule of Nines adjusted for ages 0 to 8. The BOQ 0–5 consists of ten scales, ranging from play to appearance, whereas the BOQ 6–18 consists of 12 scales addressing physical functioning A burn is an injury to the skin or other organic tissue primarily caused by exposure to heat or other causative agents (radiation, electricity, chemicals). Jul 8, 2024 · Study with Quizlet and memorize flashcards containing terms like A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n): Choose one answer. The front and back of the head and neck are 21% of the body's surface area. What percentage of burns did the child receive and more. Guide Medical Treatment. Jan 27, 2022 · Rule of nines burn chart for child, infant, baby, pediatrics, and adult. The front and back of each arm and hand are 10% of the body’s surface area. Calculating percentage of burn, example 1. Colour changes in burned skin are not always the same as in adults. Third-degree (full thickness) burns. Feb 10, 2022 · Children should also receive maintenance fluids in addition to their calculated fluid requirements. Assessment Jan 28, 2020 · Burns injuries in children are common. All paediatric burns, regardless of size, should be considered candidates for treatment. Burn children in hospitals without burns, defined as a total body surface area (TBSA) of <5%, in children aged under 16 years. 810 m 2, 0. , A 42 year old male patient has burns to the entire right and left leg, front of left arm, and anterior chest. 3 The American Burn Association estimates that 286,000 children and adults with burn injuries require medical attention in the United States. Burn may deepen over time. 7%) of the patients with recorded burn sites sustained multiple burns injuries, and more than half of the patients had upper and lower limb burns (64. Figure 3-8. 1 First aid is most effective immediately or at least within the first hours after a burn, helping to reduce production of inflammatory mediators as well as The size of a burn for a baby or young child can be quickly estimated by using the "rule of nines. For adults, the percentage TBSA for parts of the body is estimated by the rule of nines ([A] Rule of nines (for adults) and [B] Lund-Browder chart (for children) for estimating extent of burns); for smaller scattered burns, estimates can be based on the size of the patient’s entire opened hand (not the palm only), which is about 1% of TBSA Assessment of burn depth is difficult, especially early post injury; Young children are at risk of hypothermia, especially during initial cooling of the burn; Burns are described as epidermal, dermal (superficial/mid/deep) and full thickness. Learn to calculate burned surface area with the Rule of Nines on the web's most interactive Rule of Nines learning tool. b. Using the rule of nines, determine the percentage of the body surface affected 13. Study with Quizlet and memorize flashcards containing terms like What is a major cause of accidental deaths in children younger than 15, Who are at the highest risk for scald burns?, Scald burns are ranked top cause of burns, whether accidental or purposeful, to children younger than waht age? and more. 120 If a 3-year-old child has symmetric second-degree burns to both feet, what is the most common diagnosis? QUICK REFERENCE CARD: BURN STABILIZATION Rule of NiNes for adult and child 888-731-4791 (Transfer CenTer) 800-426-2430 (airlifT norThwesT 24-hour CommuniCaTion CenTer) 5. 4 About 22. The Lund and Browder chart and Rule of Nines, 2‐dimensional diagrams that are widely used, are subject to high interrater variance, and they can severely overestimate the burn area. 7° F (36. &#91;2&#93; It is among the leading causes of Burn depth assessment in a child is often more difficult due to their thinner skin. Using the rule of nines, the EMT Burns are one of the most common and devastating forms of trauma. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality 8. At temperatures greater than _____°F, it takes only 3 seconds for a child to sustain a burn injury severe enough to require surgery. Electrical Feb 13, 2020 · In children after burn injury, the Burns Outcome Questionnaire for children 0–5 years of age (BOQ 0–5) 203 and the BOQ 6–18 (ref. Management of these injuries and their consequences will be part of most busy general pediatric practices. Examples. Ice or iced water may increase the depth of the burn. B. A. A patient has received burns to the entire chest and to the left upper arm, circumferentially. This comprehensive article aims to explain the Rule of Nines, how it is applied, and its significance in determining burn severity. [7,8] Weight-based formulas tend to under-resuscitate small injuries in small children, sometimes providing even less than maintenance fluid requirements, and grossly over-resuscitate large injuries in older children. 5% of their total surface area. Default by 9s diagram, calculator, definition, examples, practice questions, and math formula included! Great for EMTs, take, medical undergraduate, USMLE, and NCLEX. 7 Care must be taken not to induce hypothermia in larger burns – especially in children. The body is divided into specific areas, and each area is assigned a percentage of total body surface area. 9-year-old with asthma and burns to the face Referral to a burn unit should occur for children with inhalation injuries, burns that involve the face, the hands and The extent of a burn is a measure of burn severity. The measurement of the initial burn surface area is important in estimating fluid resuscitation requirements, as patients with severe burns will have insensible fluid losses due to loss of the skin barrier. critical airway team should be utilized (Call 7-4300 and request surgical critical airway team) Patterned Burns • High risk finding for non-accidental trauma. Burn depth. First aid for burns The aim of first aid is to halt the burn process and to cool the burn wound. For smaller burns, the palmar surface is used and represents about 1% TBSA. 5 8. 1 Scald and contact burns account for the majority of paediatric burns in NSW, with friction burns from treadmills increasingly common. INDICATIONS FOR REFERRAL TO BURNS CENTRE. Pediatric burn injuries can be hard on the entire family. 805 m 2, respectively [Table 1]. For younger children this should be modified using a Lund-Browder burn diagram or Clinical Practice Guideline for the management of Burns in children. 2 The majority of admissions result from The American Burn Association Web site contains general information for burn care professionals and is not intended to be a substitute for professional medical advice or consultations with healthcare professionals. Therefore, a more Feb 28, 2018 · Burns are one of the most devastating types of trauma in medicine. Older people and young children are particularly vulnerable. For older children this rule is the same as in adults: head (9%), upper limbs (9% each), lower limbs (18% each), anterior trunk (18%), posterior This uses 2 ml kg 1 TBSA % burns over the same time period as the Parkland formula. The size of a burn for a baby or young child can be quickly estimated by using the “rule of nines. Sep 30, 2015 · It is imperative to prevent hypothermia in burn patients, as body temperatures below 97. Take photos with consent before and after cleaning. 2011 Nov:37(7):1233-40. . The Rule of 9 Burns is used to assess the severity of burns in patients and determine the appropriate treatment. 10-year-old with partial-thickness or second-degree burns over 15% of the body D. Only 40% of patients received prehospital intervention. It is not accurate in children. Estimate burn size to the nearest 10%. Figure 3-5. Children requiring intensive care or who cannot be admitted to QVH will need transfer to a tertiary facility. 7 m 2 for male, female and combined, respectively. Feb 12, 2024 · Prieto MF, Acha B, Gómez-Cía T, Fondón I, Serrano C. 5% respectively). These burns, in addition to being the most common in children, also are the most common type of burn seen in child abuse. For larger burns the paediatric rule of nines can be used. 6 m 2 and 1. The mean TBSA for male child, female child and combined were 0. Rule of Nines is used in second degree burns, third degree burns, partial thickness burns, full thick Jan 4, 2023 · There are multiple methods of assessing burn TBSA in children. Fourth-degree burns. The rule of nines separates the body into regions of 9% of the body’s surface area. D. Multiply %TBSAx10 = Initial fluid rate in mL/hr (for adult patients weighing 40 kg to 80 kg). Children require burns resuscitation fluid at a lesser Total Burn Surface Area (TBSA) percentage than adults (10% in children as opposed to 20% in adults). Comprehensive resources to prevent, diagnose, and manage child/adolescent abuse victims . 5% of all trauma cases) are admitted for burns management. 1016/j. Burn center referral If your child is experiencing a burn emergency, please call 9-1-1. The mechanisms that result in burns and their classification will be reviewed here. The clinical assessment and management of burns in adults and children are discussed elsewhere. The second priority is to cool the burn with ‘tap’ water (12 - 18°) for 20 - 30 minutes. Image reproduced with permission from: Australian & New Zealand Burn Association, Emergency Management of Severe Burns Course Manual 19th Ed. , A 16 year old male patient has full thickness burns to the anterior and May 10, 2024 · Burns that do not exceed 20% of TBSA according to the Rule of Nines produces a local response. Nov 27, 2021 · Babies and children under 14 have different rules for estimating a burn’s percentage of total body surface area. Chemical burns 6. 221) are valuable resources for quality of life assessment. 2 Initial management of a patient presenting with a burn involves The Rule of Nines is used to calculate total body surface for a patient who has experienced burns. contusion. 5 Nov 8, 2023 - Rule of nines burn chart for child, infant, baby, pediatrics, and adult. 5% of all burns occur in children and youth. The Rule of 9s Purpose: In this work, the potential usefulness of silver nanoparticles (AgNPs) for treating burn wounds was examined. Burn Calculations Rule of Nines Lund and Browder Chart Age 0 1 5 10 15 Adult A=Half of Head 9. Child (pediatric), infant, and adult calculator, formula, definitions, practice questions, quiz. Burns are common injuries in the paediatric population and comprise a significant epidemiological problem worldwide. Generally speaking, burns covering more than 10% of the body are considered “critical,” as are • Burns that cover the hands, feet, face, groin, buttocks or a major joint Most (62. Third-degree burns destroy the epidermis and dermis. 75 Jun 1, 2018 · Burn injuries are common in children. Outcome after burn injuries in children has substantially improved over the last few decades. Diagrams and printable charts for EMTs, nursing, medical students. Box 1 Criteria for transferring a child to a specialist burns unit Burn >5% body Using the rule of nines what is his percent of body surface area burned, A 42 year old male has circumferential burns of both his legs and genitals. The ABA is unable to respond to requests regarding personal medical concerns related to burn injuries. &#91;1&#93; It is the result of energy transfer to the body. Most childhood burns occur at home under parental supervision. Calculating percentage of burn, example 2. Figure 3-7. pediatric patients have more surface area relative to total body mass b. Individuals older than 50 years sustain the fewest number of serious burn injuries. The burn site may look white or blackened and charred. Quiz yourself with questions and answers for Rule of 9's Quiz, so you can be ready for test day. 1,2 Burns are a leading cause of accidental death in the pediatric population; they are the third leading cause of accidental death after motor vehicle deaths and drowning. Burns : journal of the International Society for Burn Injuries. Methods: Second-degree burns were induced in male Wistar rats by touching the Feb 20, 2023 · Burns are acute wounds caused by an isolated, non-recurring insult, and healing ideally progresses rapidly through an orderly series of steps . Study with Quizlet and memorize flashcards containing terms like A female patient has sustained burns to the back of the left arm, posterior trunk, front of the left leg, anterior head and neck, and perineum. Rule of 9s diagram, calculator, definition, examples, practice questions, and math formula included! Great for EMTs, nursing, medical students, USMLE, and NCLEX. 5 B=Half of Thigh 2. Cover the patient with a clean, dry covering such as a sheet or blanket to prevent evaporative heat loss. Epub 2011 Jun 23 [PubMed PMID: 21703768] Sep 2, 2022 · The most common way of calculating this is by using the rule of nines. Scalds are still a common childhood injury, but with new biological dressings they are not always the irreversible disfiguring injuries of the past Jan 1, 2024 · It is important to elicit the mechanism of a thermal burn as part of a thorough history. Majority (76%) of burns were due to scalds. Jan 10, 2019 · A retrospective review of five hundred and seven consecutive admissions to a state-wide paediatric burns unit over a three year period was made to assess the characteristics of the burn injuries Estimating Percent Total Body Surface Area in Children Affected by Burns (A) Rule of "nines" (B) Lund-Browder diagram for estimating extent of burns (Adapted from The Treatment of Burns, edition 2, Artz CP and Moncrief JA, Philadelphia, WB Saunders Company, 1969) Oct 3, 2022 · Wallace Rule of Nines and Palmer Method. Early discussion with your regional burns centre is advised if there is any doubt/concern regarding the management of any burns patient. Jan 27, 2022 · The Rule of Nines can be used in burn patients to estimate the total body surface area affected by partial thickness (2nd-degree) and full thickness (3rd-degree) burns. Although most burns in children are small and can be managed with care provided in the outpatient setting, there is a significant number of children with more serious burn injuries whose acute and long-term management will involve a collaboration ; Burns may be the result of child abuse and neglect. Rule of Nines Adults (Age ≥ 14 years) Role of Nines for Children (Age 1-14 years) Rule of Nines for Infant (Age < 1 year) Palmer Method. Even then, applying the rule of nines to a young child is a great start. This article describes the most common patterns of burn injuries encountered in clinical practice as well as the basic principles of burn wound pathophysiology. Any patients with burns & concomitant trauma in which the burn injury poses the greatest risk of morbidity or morality 9. This burn tricks some people because they see “charring” and mistakenly classify it as a full-thickness burn. What percentage of his body is burned, A three-year-old male has received full thickness burns covering the arms, posterior trunk and right leg. Lund and Browder chart—This chart, if used correctly, is the most accurate method. 5% of the body's surface area. The burns are partial- and full-thickness burns. 2024. Note the blisters, wet appearance and missing layer of epidermis characteristic of the partial thickness burn. It compensates for the variation in body shape with age and therefore can give an accurate assessment of burns area in children. Use the following table to assess the depth of the burn. 77 Burn Assessment, Rule of Nines. According to the World Health Organization (WHO), it is a global public health problem, causing an estimated 180,000 deaths annually. The following is a breakdown of the percentages assigned to each section of the body: Jul 26, 2023 · The Rule of Nines is a widely used tool in emergency medicine and burn care to quickly estimate the extent of burns on the body surface. May 20, 2022 · The image is a partial thickness burn. 1 Burn injuries account for nearly 120,000 ED visits for patients younger than the age of 20. The Rule of Nines estimation of body surface area burned is based on assigning percentages to different body areas. Online medical learning, class and course book supplement. crush injury. pediatric patients have a proportionately larger volume of blood Figure 3-4. A system for 3D representation of burns and calculation of burnt skin area. PDF version for print: Determining Total Body Surface Area (PDF) Courtesy of the American Burn Association. Total body surface area (TBSA) is the assessment of injuries or any diseases associated with skin caused because of burns or psoriasis. , Marks: 1 According to the rule of palm method for estimating the extent of a patient's burns, the palm of the patient's hand is equal to _____ of his or her total BSA Feb 12, 2024 · The Rule of Nines, also known as the Wallace Rule of Nines, is a tool utilized by medical providers to assess the total body surface area (TBSA) involved in burn patients. Assessment History of burn. Time of injury; Mechanism of injury, including circumstance for specific Jun 20, 2023 · Burns with greater than 15% body surface area (BSA) in adults and 10% BSA in children require formal fluid resuscitation, calculated with the Lund and Browder chart for children and the Wallace rule of 9s for adults. Child Abuse Evaluation & Treatment for Medical Providers. 018. The simple way to calculate maintenance fluids in pediatric patients is using the 4-2-1 rule. The commonest burn locations were the trunk and upper limbs (56%). doi: 10. Approximately 6,600 (17. Hospitals without qualified personnel or equipment for the care of children should transfer children with burns to a Verified Burn Center with these capabilities Burn injury in children who will require special social/emotional and/or long-term rehabilitative support, including cases involving suspected child abuse or substance abuse Burns to pediatric patients are generally considered more serious than burns to adults because: a. Knowing what percent each segment of the body is, add up the total area burned. The ‘crystalloid vs colloid’ debate is a subject that gener-ates a lot of interest. Please JHACH Physical Child Abuse Clinical Pathway Burn-like Diseases Diseases that mimic the appearance of burn-injuries and may vary in depth (e. hematoma. Critically ill burn patients are best cared for at a dedicated burn center, particularly those who have any of the following: • Partial-thickness burns to > 10% of total body surface area. Rule of nines for adult body surface burns. Calculating the precise total burn surface area is crucial when treating burn patients, particularly children. Calculating the total surface body area of burns in rule of nines child calculator aids in finding the severity of burns and providing the favorable treatments. Figure 3-6. The front and back of the head and neck are 21% of the body’s surface area. They are the fifth most common presentation of non-fatal childhood injuries worldwide (WHO). Rule of Nines (9s) burn chart pdf. 5 6. C. Burns > 10 % TBSA in an Adult; Burns > 5 % TBSA in a Child; Full thickness burns > 5% TBSA; Burns of face, hands, feet, perineum, genitalia, and major joints Nov 24, 2020 · The depth of a burn injury depends on the temperature and duration of exposure to the heat source as well as the patient’s age. Jan 28, 2020 · Burns injuries in children are common. When children and older people are burned, doctors also consider the possibility that the person was abused (see Child Neglect and Abuse and Elder How to Use the Rule of 9 Burns. For example, if an adult patient burns his or her entire chest/abdomen (18%) and left leg (18%), the patient Study with Quizlet and memorize flashcards containing terms like When applying the rule of nines to a 10-month-old child, the EMT should recognize which statement to be accurate?, Why would an EMT be concerned about a partial-thickness burn circumferentially to the chest?, A patient has full-thickness burns to the fronts of both legs and the entire left arm. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Jun 16, 2022 · Background and aims. Less Serious burn injuries occur most commonly in males, and in particular, young adult males ages 20 to 29 years of age, followed by children under 9 years of age. 42% of those in children between the ages of 5 to Nov 16, 2023 · The size of a burn for a baby or young child can be quickly estimated by using the "rule of nines. Many other rules for estimating a burn’s size can apply to patients who are obese. The measurement of the initial burn surface area is important in estimating fluid resuscitation requirements, as patients with s … Burn injuries are common, with approximately 1% of the Australian and New Zealand population seeking medical assistance for a burn injury each year; many patients with burns are children. The most common type is thermal burn caused by hot fluids (scald). Generally speaking, burns covering more than 10% of the body are considered “critical,” as are • Burns that cover the hands, feet, face, groin, buttocks or a major joint Each Anterior Arm: Each anterior arm area of a child accounts for approximately 6. Mar 13, 2021 · The total body surface area (TBSA) of a burn can be calculated with a Lund and Browder Chart, Wallace Rule-of-Nines or the palmar method. For more information on burns in child abuse, refer to the subsection on this topic. These values were less as compared to western population which is 1. The Rule of Nines, also known as the Wallace Rule of Nines, is a tool utilized by medical providers to assess the total body surface area (TBSA) involved in burn patients. Examples of calculating the percentage of burn are given in figures 3-6 through 3-8. 5 4. abrasion. Vietnamese: Để dịch trang web này, bạn phải nâng cấp trình duyệt của mình lên phiên bản Microsoft Edge mới nhất. 6-year-old with burns involving the knees and hips C. Online medical education and learn A 4-year-old child is being transported to the trauma center from a local community hospital for treatment of a burn injury that is estimated as covering over 40% of the body. 25 4. 4 years (IQR = 5. These are preventable injuries. The… Jun 26, 2024 · The rule of nines only applies to an adult person – for a child's assessment, scroll down – and, together with the Parkland formula, helps guide the treatment decisions regarding fluid resuscitation and whether a patient should be transferred to a specialized burn center. Explore quizzes and practice tests created by teachers and students or create one from your course material. 8) years and 149 (82%) were children below 18 years. It is expressed as the total burn surface area (TBSA), which is the percentage of the body surface area (BSA) affected. Maintenance fluids in children (4-2-1 Rule): 4mL/kg/hr for the first 10 kg of weight plus; 2mL/kg/hr for the next 10 kg of weight plus; Jan 15, 2013 · Trick of the Trade. There are three main methods for estimating TBSA: the Lund and Browder method, Wallace's Rule of Nines, and the Rule of Palm. Scalds and Burns 1 Introduction; Burn is a leading cause of unintentional injury in children, second only to motor vehicle accidents. The front and back of each arm and hand are 10% of the body's surface area. While not all burns are life-threatening, they all involve stress and a scared child and require care that is personalized to that child and their family. Rule of nines for small child body surface burns. For older children this rule is the same as in adults: head (9%), upper limbs (9% each), lower limbs (18% each), anterior trunk (18%), posterior trunk (18%), and genitalia/perineum (1%). Survival following burns of 100% surface area is now possible. Key aspects of clinical management including assessment of burn depth and total burn surface area are described and Children also require more fluid for burn shock resuscitation than adults with similar thermal injury. 5° C) in the first 24 hours are associated with increased mortality. Cooling the burn prevents the zone of coagulation spreading and can be effective up to 3 hours after the injury. 1 An estimated 37,700 children per year attend emergency departments in England and Wales. Children under 5 years of age are a high-risk group to burns. Use the rule of nines calculator to guide the medical treatment of burn patients. These include: Burns in children < 6 months of age Burns > 10% in children 6 months – 1 year of age Burns >15% in children 1 – 5 years of age Burns > 20% in children 5 – 16 years of age NCBI Bookshelf. The systemic response is caused by the release of cytokines and other mediators into the systemic circulation. Genitalia/Perineum: The combined area of the genitalia and perineum constitutes only 1% of a child's total surface area More than 2 million people in the United States require treatment for burns each year, and between 3,000 and 4,000 die of severe burns. Based on the percentage of total body surface area that is burned, the provider can calculate the amount of fluid replacement (Lactated Ringer's) the patient will need during the first 24 hours after the burn using the Parkland's Burn Formula. ” This method divides a baby’s body surface area into percentages. The younger child is the most common victim of burns that have been caused by liquids. burns. 800 m 2 and 0. 6% & 59. Mar 20, 2020 · Of the 182 burn patients whose data was analyzed, the median age was 2. 5 5. This may be due to short stature of Indian adults. Rule of nines definition, calculator, formula, examples, practice questions, quiz, and diagrams included! Study guide pdf for EMTs, nursing, medical students, USMLE, NCLEX. A service of the National Library of Medicine, National Institutes of Health. They have proportionally larger heads and shorter legs than adults. Knowing the total body surface area (TBSA) involved will help guide the patient’s care, provide an estimate for fluid resuscitation, and determine if the patient requires care Jul 7, 2004 · The body is divided into areas of 9%, and the total burn area can be calculated. 3 Rule of nines’ for adults and children. They may go into the innermost layer of skin, the subcutaneous tissue. 2011. 75 3. 1 An estimated 37,700 children per year attend emergency departments in England and Wales. The chapter presents results of my studies about risk factors of burns in children and possibilities of A. ; The leading cause of burns in the majority is scalds (70–85%) followed by flame burns, electrical, and chemical burns. Small children are short in the leg, and “top heavy” so the percentages are changed. Adults and children have different body proportions, so the Rule of Nines is different for children. For example, the immersion time needed to induce a burn injury following exposure to water heated to 54 °C is 30 seconds in an adult, 10 seconds in a child, and less than 5 seconds in an infant. An accurate estimation of a burn guides acute management, fluid resuscitation, nutrition supplementation and prognosis. Calculations for pediatric child, adult, and infant baby. Many believe that the initial fluid of Fig. le bl uf yi uq wa ab pv zh zf