Another Burn Situation (More Minor), Thoughts?

[jyl]

My daughter has burned the balls of her feet on hot pavement. I'd appreciate some advice.

Here's the situation. 16 y/o girl is going to her summer job at camp in Yosemite. She flies from Portland to Oakland, a family friend from Berkeley picks her up and drives her to the camp. While the minivan is climbing one of the mountain roads, something blows out an open window. They stop and my daughter jumps out to retrieve whatever it was. She is barefoot, the pavement is very hot. They arrive at camp and the camp head looks at her feet, and says you have second degree burns, you need to go back to Berkeley. So they are in the minivan headed back down the hill.

She has large yellowy blisters on the balls of both feet. The blisters are not popped or oozing. There is not redness. Feet hurt to walk on but otherwise not too painful. Here is a picture she texted me.



I'm trying to figure out:

1. Degree of burn. Immediate care? (I told her to stay off her feet, don't pop the blister, clean them with an antiseptic.)

2. Go to ER when they arrive in Berkeley (about 2 hours from now)? Go to friend's house, take it easy, go to local urgent care clinic or her old Berkeley pediatrician (if they'll see her) when they open on Monday? Go to neither unless conditions change?

3. Daughter is a minor, family friend does not have power of attorney/guardian etc. The camp head has the power to authorize treatment, but she's not at camp. So - can daughter even be treated absent a life-threatening emergency, which this is not? Will treatment have to wait until my wife gets down there?
[Wife was scheduled to drive with son to Berkeley this coming Tuesday and they were going to camp later in the week, then various other road trippy stuff. She can leave tommorrow, and if needed they could get on a plane instead of doing the driving thing.]

Sigh. Kind of a monkey wrench in her summer plans.

[jyl]

Oh, any idea how long it takes for something like this to heal enough to walk and stand for hours? She wants to give the camp some idea when she'll be able to return.

[TimT]

Life will suck for her for awhile...

I had similar burns on the balls of my feet after playing touch football at the beach in the Sinai ..

Those blisters will break, the skin underneath will have to get toughened up ... by treading lightly...

[azasadny]

Ouch! Can she get some Silvadene ointment and gauze to cover those blisters?

[Zeke]

Looks like the typical 10 day heal. It will be longer than that before she develops much of a barefoot sole. Probably didn't have much of one to start with or that wouldn't have happened. People have to break in their winter feet somewhat gradually. Not like us SoCal beach bums.

[masraum]

I had the same thing happen when I was 15. Blisters mean second degree burn. Not really a big deal in this case I suspect. In my case I didn't do anything for the burns. No, I just put my shoes and socks back on. The blisters popped and the skin eventually tore off. It was ender to walk for a while, but not excruciating.

[Mark Howard]

Been there before many times with heat blisters from long road marches during my infantry days. My advice, clean the area well, pop the blisters and drain the fluid, silvadene for two days only (can prevent healing after a couple days), gauze the area over the silvadene and under socks. Wear tennis shoes as tight as she can stand to prevent friction. After two days, switch to neosporin or some other antibacterial ointment. Three or so days it will be tender, skin will dry out and fall or can be cut off. Agree with the above, 10 days it will be fine. Most of all, keep clean and dry.

Good luck to her.

[jyl]

Thanks everyone!

Now, about that espresso machine . . .

[Bill Douglas]

Yep, I had burns like that once. I just put it in the "won't do that again" basket.

[aigel]

I had these stepping in some hot ashes from a fire the night before. Same age too. I remember them being painful but healing up pretty quickly. I wouldn't send someone home from camp for that. I'd tape it up with a good first aid tape keeping the blister intact and keep going. By the time it pops / breaks open, there will be serviceable skin underneath. I don't think this is a ER visit.

Looking ahead, ask your daughter to wear shoes and not flip flops when traveling or outside the house. I beat on my kids to wear decent shoes when we are not home and especially when we drive in the car. You never know when you need to run in an emergency. We do live in earthquake country for example.

One thing I witnessed a few years ago was was a couple running after their dog on the I5 center divide after they were in an accident and apparently opened the door and the pooch took of. They were both in flip flops and could barely run. They could have caught that toy dog in a decent shoe within half a minute ... I also only travel with my dogs in crates after seeing that sad situation.

I really like being barefoot, but have a pair of 5 fingers I wear when away from home. I can put down a mean sprint in those and a hot pavement or piece of glass wouldn't put me out of business.

G

[azasadny]

I still have a large roll of moleskin in my basement from my Corpsman days with the Marines. The stuff works!!

[Noah930]

Maybe a little late, but blistering usually indicates a 2nd degree burn. 1st degree is something like a sunburn. 2nd degree is a partial-thickness burn. It even gets divided up into shallow 2nd degree and deep 2nd degree. 3rd degree is full-thickness burn. Skin is described as white and leathery. Not painful because you've burned off all the nerve endings. You can often guess at what severity a burn will be, but sometimes it can take a couple days for a burn to "declare itself."

If you've got blistering and pain and based upon the mechanism of injury, it's likely a mild 2nd degree. Keep the feet clean. Different schools of thought on what to do with the blisters. I'm of the keep the blisters intact camp (at least until they rupture by themselves), though others argue to debride (cut) them away as soon as possible to drain any fluid underneath them. Your skin has 2 major functions: keep fluid in, and provide a barrier against infection. When skin gets burned, those two functions are compromised. Hence the desire to keep the area as clean as possible and to keep it covered. Often Silvadene cream will be used for moisture and preventing infection. You butter it on the wound (or on the gauze, itself) and then apply to the burn. Change every 12 hours. Wash with saline in between. There are theoretical risks (neutropenia) with prolonged Silvadene risk, so this isn't an over-the-counter item. Overall, looks like this type of wound would heal in an otherwise healthy 16 year-old in a couple weeks.

[Tobra]

Intact blisters, leave intact. Popped, you unroof them and apply dressing. Silvadene is great, but a prescription item. Spenco second skin is OTC, they are little gel squares that will keep it moist. She will have a hitch in her giddyup for a few weeks, watch for signs of infection.

[azasadny]

Silvadene made my deep 2nd degree burn feel much better. The Xeroform gauze also helped, but those are both prescription items, I believe. I do not like to open the blisters, we used to take a sterile need and draw out the fluid under the blister, then inject a tiny amount of tincture of benzoin, way back in the day, but that's not recommended any more. It stung like hell but let the Marine keep marching. Moleskin is a great invention, too!!

[jyl]

Quick update and question. We are now 5 days post-burn.

Daughter reports (she is still down in Berkeley) that her feet do not hurt and are not infected, the blisters are intact (not popped). She can walk slowly with Crocs. She's been carefully cleaning and bandaging the blisters, while reading every book she can get her hands on - bored to death.

However, the blisters are big and full enough that she can't walk normally yet.

Question is - should she open and drain the blisters (sterile needle), then disinfect/bandage? Or let the healing go on, under the blisters, for a couple more days?

She goes back up to camp on Saturday, so she'd like to be able to walk more by then.

[azasadny]

I would leave the ontact blister alone as it's protecting the healing tissue beneath it. She may get it infected, so tell her to keep it clean.

[vash]

if there is anything you need me to do..(drop off meds, etc) ask.

my coworker stepped on his GF's hair-tool. some sort of straightening thing..dunno doesnt matter.

he burned himself Bad!! it was less than 5 days and he was moving around limpfree.

[Rikao4]

like Noah said..
2 camps..
until the blister leaks..
not much is really happening..
once they leak..
she needs to be careful..
keep dry and clean..
within a few days..
the blister will dry out & peel off.

Rika

[72doug2,2S]

Originally Posted by Tobra

Intact blisters, leave intact. Popped, you unroof them and apply dressing. Silvadene is great, but a prescription item. Spenco second skin is OTC, they are little gel squares that will keep it moist. She will have a hitch in her giddyup for a few weeks, watch for signs of infection.

+1

How about keeping them open to the air as much as possible. Won't that help shrink the blisters. Once they shrink down she'll still need to be careful. I think they'll eventually break and peel regardless.

[aigel]

Keep intact. It is nicely sealed and the skin underneath will be ready to go once they do break on their own.

Buy her a nice set of shoes and have them delivered.

G