How to treat painful blisters with spared red areas as a wilderness first responder and nursing assistant?

Management of Painful Blisters with Spared Red Areas in Wilderness and Clinical Settings

For painful blisters with spared red areas, gently cleanse with antimicrobial solution, pierce blisters at the base to drain fluid while leaving the roof intact, apply antimicrobial ointment, and cover with non-adherent dressing to promote healing and prevent infection. 1

Initial Assessment and Approach

• Assess the extent of blistering, pain level, and check for signs of infection (increased redness, warmth, swelling, purulent drainage) 1
• Perform proper hand hygiene with soap and water for at least 20 seconds before and after providing care to prevent infection transmission 1
• Use personal protective equipment (PPE) such as gloves when available to minimize risk of disease transmission 1

Wilderness First Responder Management

Blister Care Protocol

• Gently cleanse the blisters with antimicrobial solution or clean potable water, taking care not to rupture them prematurely 1
• Pierce blisters at their base using a sterile needle (if available) with the bevel facing up, selecting a site where fluid will drain by gravity 1
• Do not remove the blister roof as it serves as a biological dressing that promotes healing and reduces pain 1
• Gently apply pressure with sterile gauze to facilitate drainage and absorb fluid 1
• After drainage, cleanse again with antimicrobial solution or clean water 1

Pain Management

• Offer appropriate analgesia prior to blister care procedures as many patients report pain or burning sensation during treatment 1
• Continue cooling the affected area until pain is relieved, but avoid applying ice directly to the skin as it can produce tissue ischemia 1

Wound Care After Drainage

• Apply antibiotic ointment (such as bacitracin) to reduce infection risk if the person has no known allergies 1, 2
• Cover with a non-adherent dressing to protect the area while allowing healing 1
• In wilderness settings, improvised clean dressings may be used if standard medical supplies are unavailable 1

Nursing Assistant Management (Clinical Setting)

Enhanced Blister Documentation and Care

• Document the number and location of blisters on a blister chart to track progression 1
• For larger blisters, multiple drainage points may be necessary - use a larger needle and pierce more than once 1
• Apply a bland emollient such as 50% white soft paraffin and 50% liquid paraffin to support barrier function and encourage re-epithelialization 1

Infection Prevention

• Change dressings using aseptic technique 1
• Monitor closely for signs of infection, as infection increases risk of scarring and is a significant cause of morbidity 1
• Daily washing with an antibacterial product can decrease bacterial colonization 1
• If clinical signs of infection develop, obtain bacterial and viral swabs and consider topical antimicrobials for short periods 1

Special Considerations

• For burns with blisters, cool thermal burns with cold (15° to 25°C) tap water as soon as possible and continue cooling until pain is relieved 1, 3
• For children, be gentle and consider their emotional concerns; attempt to calm them and possibly engage their caregiver 1
• For extensive blistering affecting >10% of total body surface area (>5% in children), seek immediate medical attention 3

Common Pitfalls to Avoid

• Do not apply ice directly to blisters or burns as it can cause tissue ischemia 1, 3
• Do not remove the blister roof (deroofing) as this increases infection risk and delays healing 1
• Avoid applying butter, oil, or other home remedies to blisters or burns 3
• Do not delay seeking medical attention for extensive blistering or signs of infection 3, 4

When to Evacuate/Seek Advanced Care

• If blisters cover large areas of the body (>10% TBSA in adults, >5% in children) 3
• If there are signs of infection (increasing pain, redness, warmth, swelling, purulent drainage) 1
• If blisters involve critical areas such as face, hands, feet, or joints 3
• If the person shows signs of systemic illness (fever, chills, malaise) 1, 4