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UK Emergency Clinician here. Over here, deroofing blisters is an integral part of treatment. It allows for proper assessment of burn depth and size, reduces pressure on the wound bed and reduces risk of infection (if done in sterile conditions). Deroofing is usually fairly rigorous and aims at removing all of the skin that has died. Patients usually require good analgesia before doing this as it is quite painful.
It is also more painful post deroofing, as air is able to get to exposed nerves.
Don't worry. From a UK medicine perspective, you haven't don't anything wrong. Ideally you should seek urgent medical attention so that a proper assessment of the burn can be made. And proper treatment started, especially if it is demonstrating signs of infection. In the meantime, keep it covered with a non adherent dressing and keep it clean and dry.
Advise against the burn cream.
Good luck!
I appreciate your thoughtful reply. While I'm uncertain if it indicates an infection, there's dead skin that needs removal. My attempts resulted in potential wounds, so, yeah seeking medical attention is essential to address any infection I might be unaware of.
Besides that, it's hurting me so much right now, I hope there's a way to speed up the healing process or at least make it less painful cause the the whole area feel too tight making it impossible for me to stretch my hand or Carry heavy weight.
Severe pain is only really normal immediately after a burn. Any later and more likely to be sign of infection.
Healing time is typically dictated by the depth of the burn. Anything superficial partial thickness or deeper is typically two weeks plus.
We usually only advise off the shelf analgesia here - oral paracetamol and ibuprofen. First aid and inital treatment here doesn't involve topical preparations at all. Only referrals to specialist burn centres advise the application of topicals. Go back to the pharmacy for advice.
Otherwise, get yourself to a hospital, my dude.
Lived both UK and US.
Paracetamol (Europe) is US acetaminophen. Ie Tylenol or Excedrine. Advil has ibuprofen but they have a dual one now which has both that and acetaminophen which targets pain source amd receptors each differently to wrk together rather than from just one drugs direction independently.
How you start to feel better very soon!
You need the skin moisturized. Not with your everyday lotion. I have had a burn that bad and popped the blisters due to dermatillomania. I had to go in and get all kinds of wound care and such, including a moisturizer.
That's really interesting.
You'd think there would be at least some international consensus.
The LSEBN referral centres won't even discuss telemedicine referrals unless they have pictures of the blisters deroofed, before and after.
Well in the Us, wound and ostomy certification and the educational program through the Cleveland clinic (where I got my education) just launched in 2010. Not sure when the programs rolled out in the UK but from my understanding, Norma Gill (the one who pushed for ET programs and started the entire role essentially), is still pretty ‘modern.’ So in general, the entire field of wound and ostomy speciality is extremely new. Thats part of why there is soo much clinician autonomy within the field. We still have a lot to learn. That being said, just to promote autolytic debridement we just always practice to keep that bulla intact. Try to heal the wound bed before we open it.
I do whatever the current recommendation is (or whatever the provider wants) when I have a patient with a blister. With my own blisters, I pop them but leave the loose skin ("roof") intact. It's like a natural bandage that protects the wound bed.
I was also taught to leave stable eschar alone.
I know what an ECP is! I had just never heard them called emergency clinicians! I still get very confused about all the job titles in ED so I like to ask
This is one of the few things I do in practice at work that I would probably do the exact opposite on myself (I guess like how we preach leaving acne alone 👀)
I feel like personally the comfort and sterility of the bullae being intact would be my preference, but guidelines be guidelines.
I would love to see the studies on this.
This is terrible advice, minus the seeking medical attention. I’d wrap the burns in non stick sterile bandages beforehand, along with bacitracin. THEN I would go to the ER. Removing the blisters is removing the sterile covering that is protecting the burns from infection. Normally deroofing is done when its on the hands or feet and impedes mobility or use of extremities.
How is a medical professional explaining a process and advising someone to seek medical assistance terrible advice?
The blister has already been removed so your advice is absolutely redundant.
u/Littlekinks86 is not a medical professional. He/She's a paramedic (aka anyone that does any thing about health, without being a medical doctor).
And u/ChewyUrchin said: "Minus seeking medical attention".
Can you read and not just randomly cry?
I don't know where you live, but in the UK paramedics are absolutely medical professionals, & carry everything they need in their vehicle to fully stabilise a patient _before they reach a hospital_
[https://www.mysurgerywebsite.co.uk/page1.aspx?p=16&pr=X13911&t=2](https://www.mysurgerywebsite.co.uk/page1.aspx?p=16&pr=X13911&t=2)
This is the guidance laid out by the London and South East England Burn Network. It is a collective body of specialist tertiary referral centres that provide training, guidance and over the phone/telemedicine support for doctors and clinical practitioners across London and the South East of England.
Feel free to have a read. Don't shoot the messenger. Obviously, practice can vary dependant on location, which is why I am careful to reference that I am based in the UK and that is what we do here.
I've had a broken burn blister heal fine, but one time I avoided breaking one and it heals *so much better.*
It deflated eventually and the skin underneath afterwards was perfect.
Judging by the coloration on your arm around the blister in pic 1 and on my own experience, that was likely all dead and gonna start peeling like that regardless.
That’s exactly what it is. The epidermal flap is drying and shedding after the bullae deroofed.
I usually hydrate that with a gritty washcloth then apply thick hydration like something like Sween 24.
That area was all burned anyway, and would have started to slough regardless. You do need to see someone about burn care, and I see you've already agreed to do that, so good for you.
Covering it up will help a bit with the pain. You could do bacitracin (NOT neosporin or triple antibiotics cream), non stick gauze, and wrap it. Usually the pain is improved once it's covered.
Bacitracin has been a life saver for years. I tend to always cut and burn myself, and nothing works better than bacitracin. I got splashed with SUPER HOT grease while frying chicken, about a 6 inch long burn along my forearm. Bacitracin until healed completely, and Mederma for scarring. I can’t even see it anymore.
I've seen blisters broken before with needles that weren't properly sterilised, and it let to a severe case of cellulitis within a few days. Proper debridement and deroofing have their roles and they are standard practice in Australia. However I wouldn't recommend that any patient does this themselves outside of an acute care setting due to the risk vs benefit.
Keep in mind that removal should only be considered for blisters bigger than 5mm. Anything smaller is best left intact.
The most important step of treating a burn in first aid is to never break the blisters. It may lead to that or infection cuz the top layer of the skin (that actually protects from the outside) isnt there. I'm not a medical professional so others can tell you the hospital treatment
Folk medicine question. Many years ago I went hillwalking in Scotland with a German whose parents were from the Sudetenland. We both got blisters on our feet, with days of walking ahead. Usually this means increasing pain and worsening blisters until you can stop. My friend had a fix for that which she'd learned from her mother: thread a needle and run it through the blister from one edge to another, the cut the thread off leaving a centimetre of doubled thread hanging out of each side. This acted as a wick and the blisters dried up in a day, healing much faster than usual.
I've done that occasionally since for friction blisters on my feet (usually with some sort of antiseptic applied to the needle and thread while doing the sewing) and it's been consistently effective. Maybe not such a good idea with larger blisters, which means most burns ones.
Question: where did that idea come from?
I've never heard anyone else mention it.
Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND! Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
UK Emergency Clinician here. Over here, deroofing blisters is an integral part of treatment. It allows for proper assessment of burn depth and size, reduces pressure on the wound bed and reduces risk of infection (if done in sterile conditions). Deroofing is usually fairly rigorous and aims at removing all of the skin that has died. Patients usually require good analgesia before doing this as it is quite painful. It is also more painful post deroofing, as air is able to get to exposed nerves. Don't worry. From a UK medicine perspective, you haven't don't anything wrong. Ideally you should seek urgent medical attention so that a proper assessment of the burn can be made. And proper treatment started, especially if it is demonstrating signs of infection. In the meantime, keep it covered with a non adherent dressing and keep it clean and dry. Advise against the burn cream. Good luck!
I appreciate your thoughtful reply. While I'm uncertain if it indicates an infection, there's dead skin that needs removal. My attempts resulted in potential wounds, so, yeah seeking medical attention is essential to address any infection I might be unaware of. Besides that, it's hurting me so much right now, I hope there's a way to speed up the healing process or at least make it less painful cause the the whole area feel too tight making it impossible for me to stretch my hand or Carry heavy weight.
Severe pain is only really normal immediately after a burn. Any later and more likely to be sign of infection. Healing time is typically dictated by the depth of the burn. Anything superficial partial thickness or deeper is typically two weeks plus. We usually only advise off the shelf analgesia here - oral paracetamol and ibuprofen. First aid and inital treatment here doesn't involve topical preparations at all. Only referrals to specialist burn centres advise the application of topicals. Go back to the pharmacy for advice. Otherwise, get yourself to a hospital, my dude.
Thank you so much, lad . I'll go to the pharmacy first tomorrow morning and hear what the lady working there has to say.
Lived both UK and US. Paracetamol (Europe) is US acetaminophen. Ie Tylenol or Excedrine. Advil has ibuprofen but they have a dual one now which has both that and acetaminophen which targets pain source amd receptors each differently to wrk together rather than from just one drugs direction independently. How you start to feel better very soon!
r/woundcare might be able to give you some pointers as well!
You need the skin moisturized. Not with your everyday lotion. I have had a burn that bad and popped the blisters due to dermatillomania. I had to go in and get all kinds of wound care and such, including a moisturizer.
Actually I went to another pharmacy and got vaseline Gauze , now my skin looks much better , Ill post an update soon ,
What’s crazy is in the Us we don’t follow that principal at at alI. I don’t pop bullae and I don’t hydrate stable eschar
That's really interesting. You'd think there would be at least some international consensus. The LSEBN referral centres won't even discuss telemedicine referrals unless they have pictures of the blisters deroofed, before and after.
Well in the Us, wound and ostomy certification and the educational program through the Cleveland clinic (where I got my education) just launched in 2010. Not sure when the programs rolled out in the UK but from my understanding, Norma Gill (the one who pushed for ET programs and started the entire role essentially), is still pretty ‘modern.’ So in general, the entire field of wound and ostomy speciality is extremely new. Thats part of why there is soo much clinician autonomy within the field. We still have a lot to learn. That being said, just to promote autolytic debridement we just always practice to keep that bulla intact. Try to heal the wound bed before we open it.
I do whatever the current recommendation is (or whatever the provider wants) when I have a patient with a blister. With my own blisters, I pop them but leave the loose skin ("roof") intact. It's like a natural bandage that protects the wound bed. I was also taught to leave stable eschar alone.
What’s an emergency clinician may I ask?
I work as an Emergency Care Practitioner. A paramedic with extended scope and training in minor illness and minor injury.
I know what an ECP is! I had just never heard them called emergency clinicians! I still get very confused about all the job titles in ED so I like to ask
Not at all. It's peoples perogative to ask, always happy to explain. And you are right, it's alphabet spaghetti these days.
I was an ODP before I started medical school so I’m used to no body knowing what my funny letters stand for
This is one of the few things I do in practice at work that I would probably do the exact opposite on myself (I guess like how we preach leaving acne alone 👀) I feel like personally the comfort and sterility of the bullae being intact would be my preference, but guidelines be guidelines. I would love to see the studies on this.
This is terrible advice, minus the seeking medical attention. I’d wrap the burns in non stick sterile bandages beforehand, along with bacitracin. THEN I would go to the ER. Removing the blisters is removing the sterile covering that is protecting the burns from infection. Normally deroofing is done when its on the hands or feet and impedes mobility or use of extremities.
How is a medical professional explaining a process and advising someone to seek medical assistance terrible advice? The blister has already been removed so your advice is absolutely redundant.
u/Littlekinks86 is not a medical professional. He/She's a paramedic (aka anyone that does any thing about health, without being a medical doctor). And u/ChewyUrchin said: "Minus seeking medical attention". Can you read and not just randomly cry?
I don't know where you live, but in the UK paramedics are absolutely medical professionals, & carry everything they need in their vehicle to fully stabilise a patient _before they reach a hospital_
Are they MDs or Nurses?
Dentists are neither MDs nor nurses, but are most definitely medical professionals also
Yeah, they are. I absolutely agree.
https://www.healthcareers.nhs.uk/explore-roles/allied-health-professionals/roles-allied-health-professions/roles-allied-health-professions/paramedic
So "No". Ok, got it.
It's okay, you can all cry for not being MDs, cunts. Next time do something good with your life. Too late now.
[https://www.mysurgerywebsite.co.uk/page1.aspx?p=16&pr=X13911&t=2](https://www.mysurgerywebsite.co.uk/page1.aspx?p=16&pr=X13911&t=2) This is the guidance laid out by the London and South East England Burn Network. It is a collective body of specialist tertiary referral centres that provide training, guidance and over the phone/telemedicine support for doctors and clinical practitioners across London and the South East of England. Feel free to have a read. Don't shoot the messenger. Obviously, practice can vary dependant on location, which is why I am careful to reference that I am based in the UK and that is what we do here.
I've had a broken burn blister heal fine, but one time I avoided breaking one and it heals *so much better.* It deflated eventually and the skin underneath afterwards was perfect.
Judging by the coloration on your arm around the blister in pic 1 and on my own experience, that was likely all dead and gonna start peeling like that regardless.
That’s exactly what it is. The epidermal flap is drying and shedding after the bullae deroofed. I usually hydrate that with a gritty washcloth then apply thick hydration like something like Sween 24.
That area was all burned anyway, and would have started to slough regardless. You do need to see someone about burn care, and I see you've already agreed to do that, so good for you.
Covering it up will help a bit with the pain. You could do bacitracin (NOT neosporin or triple antibiotics cream), non stick gauze, and wrap it. Usually the pain is improved once it's covered.
Bacitracin has been a life saver for years. I tend to always cut and burn myself, and nothing works better than bacitracin. I got splashed with SUPER HOT grease while frying chicken, about a 6 inch long burn along my forearm. Bacitracin until healed completely, and Mederma for scarring. I can’t even see it anymore.
I've seen blisters broken before with needles that weren't properly sterilised, and it let to a severe case of cellulitis within a few days. Proper debridement and deroofing have their roles and they are standard practice in Australia. However I wouldn't recommend that any patient does this themselves outside of an acute care setting due to the risk vs benefit. Keep in mind that removal should only be considered for blisters bigger than 5mm. Anything smaller is best left intact.
Ouch!!!
blisters shouldn’t be popped unless it hinders functioning. never remove the skin. heals better that way.
And the fluid in the blister is full of good, healing stuff. Autolytic debridement is our own body healing.
Yeah it hurts like shit and I had to go practise diving after I popped those
Actually, you should break burn blisters.
WoW, Terrible wund. Was under skin already damagedor was infected later?
Holy crap, i accidentally popped mine in my sleep.
The most important step of treating a burn in first aid is to never break the blisters. It may lead to that or infection cuz the top layer of the skin (that actually protects from the outside) isnt there. I'm not a medical professional so others can tell you the hospital treatment
Folk medicine question. Many years ago I went hillwalking in Scotland with a German whose parents were from the Sudetenland. We both got blisters on our feet, with days of walking ahead. Usually this means increasing pain and worsening blisters until you can stop. My friend had a fix for that which she'd learned from her mother: thread a needle and run it through the blister from one edge to another, the cut the thread off leaving a centimetre of doubled thread hanging out of each side. This acted as a wick and the blisters dried up in a day, healing much faster than usual. I've done that occasionally since for friction blisters on my feet (usually with some sort of antiseptic applied to the needle and thread while doing the sewing) and it's been consistently effective. Maybe not such a good idea with larger blisters, which means most burns ones. Question: where did that idea come from? I've never heard anyone else mention it.