What is the treatment for burns with bullae?

Treatment for Burns with Bullae

For burns with bullae, the recommended treatment is to pierce the blister at its base with a sterile needle, leaving the blister roof intact as a biological dressing, followed by appropriate wound care including antimicrobial cleansing and application of bland emollients. 1, 2

Initial Management

1. Cooling the burn:

   • Apply running water at room temperature (15-25°C) for at least 10 minutes 2
   • This helps reduce pain and limit tissue damage

2. Pain management:

   • Provide analgesia prior to any blister care procedures 1
   • First-line: acetaminophen 1g every 4-6 hours
   • Second-line: add NSAIDs for inflammatory pain 2

Blister Management Protocol

1. Cleansing:

   • Gently cleanse the blister with antimicrobial solution, taking care not to rupture it 1

2. Blister drainage:

   • Pierce the blister at its base with a sterile needle (bevel facing up)
   • Select a site where fluid will drain out by gravity to discourage refilling
   • For large blisters, use a larger needle and pierce more than once 1
   • Do not remove the blister roof - it serves as a biological dressing 1, 2

3. Fluid drainage:

   • Apply gentle pressure with sterile gauze swabs to facilitate drainage 1

4. Post-drainage care:

   • Cleanse again with antimicrobial solution after fluid has drained 1
   • Apply a bland emollient such as 50% white soft paraffin and 50% liquid paraffin to support barrier function and encourage re-epithelialization 1
   • Apply a non-adherent dressing if necessary 1

Antimicrobial Treatment

• For second and third-degree burns, apply a thin layer (approximately 1/16 inch) of 1% silver sulfadiazine cream 2, 3
• Silver sulfadiazine should be applied once to twice daily 3
• Reapply immediately after hydrotherapy or when removed by patient activity 3
• Continue treatment until satisfactory healing has occurred or until the burn site is ready for grafting 3

Monitoring and Follow-up

1. Infection prevention:

   • Daily washing with an antibacterial product to decrease colonization 1
   • Change dressings using aseptic technique 1
   • Document the number and location of new blisters on a blister chart 1

2. Monitoring for infection:

   • Vigilance in detecting signs of infection is essential as it is a significant risk and major cause of mortality 1
   • If clinical signs of infection appear, obtain bacterial and viral swabs 1
   • Consider topical antimicrobials for short periods if infection is present 1
   • Use systemic antibiotics if there are local or systemic signs of infection 1

Special Considerations

• For burns covering >10% BSA in children or >20% BSA in adults: Seek immediate medical attention 2
• For burns on face, hands, feet, or genitalia: Seek immediate medical attention regardless of size 2
• For genital/intimate areas: Use white soft paraffin ointment every 4 hours during the acute phase; consider silicone dressing for erosions 2

Common Pitfalls to Avoid

1. Do not debride/remove the blister roof - this increases infection risk and pain 1, 2
2. Do not use prophylactic systemic antibiotics - focus on good wound care instead 4
3. Do not aspirate blisters - piercing causes less discomfort than aspiration 1
4. Do not underestimate the risk of infection - it is a major cause of morbidity and mortality in burn patients 5, 6
5. Do not delay treatment - prompt institution of appropriate care is of prime importance 3

By following this evidence-based approach to burn management, you can optimize healing while minimizing the risk of infection and other complications.