2nd-degree burn: supplies for pain management and healing?
December 14, 2013 2:09 AM   Subscribe

2nd-degree burns: what helped you recover from and care for yours? Any advice as I prep to leave tomorrow for a vacation where I won't have access to any big pharmacies/stores?

I burned the top of my foot (with spilled boiling water) a few hours ago. There are two entirely open blisters, each about an inch long & half an inch wide, and slightly concave/deep, along with other equally small red areas that blistered but didn't open up.

I've had help from my husband who's not a medical doctor but is a Biology phd. He says the open blisters look deep enough that we should take me to an urgent care when it opens a few hours from now, so they can be dressed well and we can get complete instructions for their care. We followed the instructions for immediate 2nd-degree burn care (cold water soak, then sterile gauze bandaging and foot now elevated).

We're leaving on a vacation tomorrow that luckily can involve plenty of relaxing (was beach-focused, but clearly I'll need to avoid beach). I need advice re. what to buy and pack -- today is my last day with access to a full pharmacy.

Right now the pain just sitting still is very intense, and if I try to take a step on the foot, it hurts unbearably. Luckily I have crutches I can bring on the vacation. I am going to need some rx pain management (I took 2 ibuprofen an hour ago and the pain's just gotten worse).

I've only had rx painkillers once in my life for a few days (Percocet) and they worked for me. My husband is really concerned by recent research on the dangers of acetaminophen so we'll be asking for painkillers without it. Is there a good way to go about asking for this, or will this be no issue with an urgent care doc? (I have a regular doc and good health insurance; I'm just leaving the country tomorrow!)
posted by kalapierson to Health & Fitness (20 answers total)
If you explain your situation, especially your recent reading (and fears) regarding acetaminophen, you won't come off as a drug seeker, and most docs won't have a problem prescribing limited amounts of analgesics. But docs vary widely in their approach to pain relief.

My big worry for you is infection prevention. Infection is a huge complication of burns and a significant danger. Besides learning the signs of infection, make sure you have an adequate supply of sterile dressings, etc. How remote is this area? You write that you won't have access to pharmacies or stores, so will you be able to get bandaging materials? If not, bring plenty along.

How about water that's clean enough for bathing the foot? Typically iodine scrubs and such are now discouraged, but if the water is questionable, you can add some betadyne (or similar) till the water is the color of a light apple juice. Let it stand that way for an hour, and it will likely be safe.

Ask the physician about possibly having an antibiotic that you would only take if an infection developed.
posted by wjm at 3:30 AM on December 14, 2013

Wow, bad luck all around, that sucks! And right before your vacation! The best thing to do is what you're already planning - get to the doc. Make sure you see them before you go fill a CVS shopping cart with any of the crap others (Or I) tell you help.

That aside, I myself have the somewhat frustrating habit of forgetting that the eyes of stoves are usually hot when they're turned on so I've burned my hands quite a few times and here's what worked for me.

1: Prescription strength ibuprofen (I forget what the exact dosage is in mg or whatever, but I know one prescription pill was as strong as 4 normal ibuprofein and I was told to take 2 for a total dosage of around 8 normal over the counter pills. I've had my doctor tell me that as long as it's not a constant habit, taking that many at a time is fine when in extreme pain, so maybe up your dosage. Talk to your own doc before downing 8, though.

2: Aloe. Definitely get some aloe gel or, better yet, buy an aloe plant with big leaves, rip a leaf open, and slather your burn with the disgusting mucous-y insides. Gross, and smells - but remarkably helpful

3: In particularly bad cases, after I returned from the doc and got their orders, I just carted a gigantic bowl of icy water around and alternated constantly between covering myself in aloe, then dunking my burn in the water when the pain got too bad to take. That soothing, instant relief... eventually though, the ice soak stops relieving the pain, so I had to dab dry, put aloe back on and wait a few minutes to "desensitize" again. Then I could re-dunk. This requires a lot of ice and constant access - but I guess if you're on vacation, your hotel should have those big ice-buckets!

Hope your vacation is relaxing despite your unlucky start - try not to let it get you down. And get to that doc!
posted by johnpoe50 at 3:33 AM on December 14, 2013

I should be horribly scarred all over my face. My mom cut open vitamin E capsules and applied the liquid to the burns. Aloe has been a big help with kitchen burns.
posted by Mr. Yuck at 3:34 AM on December 14, 2013

Honestly, I know all the instructions for treating burns say you should run it under water, etc, but I've found that letting it dry out helps the pain the fastest. YES, it hurts like a mofo while it's drying, but in my experience, cold water and cold compresses and lotions only prolong the pain. Eventually, you let it be and it dries and it stops hurting. I had a huge and horrible burn on my forearm from leaning it against the inside of the oven door by accident, and the only cure was to dry it in front of a fan.

This may be terrible advice in terms of the health of your skin, but I believe it's the best in terms of pain management. I can barely see the scar on my arm now, though. It's just a big patch of slightly darker skin than the rest of my arm, so it didn't seem to impair the healing process.
posted by SarahBellum at 3:40 AM on December 14, 2013

Response by poster: Thank you all - I agree infection is the biggest concern. I will have high quality (European standard) tap water for all of the vacation, and I'll bring plenty of sterile dressings and tape. Antibiotic rx in case of need is a really sensible idea, thanks.

Can you tell me anything about what I should be prepared for in terms of pain while changing the bandages? And more broadly, when did your pain peak? (Like, am I through the worst of it, now that I'm several hours in, or will it worsen over days?)
posted by kalapierson at 3:56 AM on December 14, 2013

I think you'd probably be surprised at how well stocked pharmacies are, even in the developing world. Any town that is big enough for any regular tourist trade will have a pharmacy with everything you need to treat minor burns, cuts and scrapes, and stuff like antibiotics and pain killers.
posted by empath at 4:04 AM on December 14, 2013 [1 favorite]

I had a large, extremely blistered second degree burn on my legs this summer. It took around 6 weeks maybe to heal, and still is visible as a whiter patch of skin on my leg. Honestly, the worst pain was for the first hour or two after the burn-- after I had it bandaged, it was much less painful. After that, changing my bandages once the blisters began to come off was EXTREMELY painful. Like, so bad I cried. Once that raw skin under your blister becomes exposed, anything that touches it at all hurts like hell. Definitely plan on keeping it covered for a month plus, and maybe take some ibuprofen before you change your bandages. I would also wet my bandages in the shower before changing them so they wouldn't stick to my skin.

Really, keeping it covered was the thing that was most stressed to me as important for burn care. So stock up on bandages! I also covered it in an antibiotic cream at first, and after that Aquaphor, to keep the skin moist.
posted by queens86 at 5:01 AM on December 14, 2013

Once that raw skin under your blister becomes exposed, anything that touches it at all hurts like hell.

If you can use those hydrocolloid burn plasters they will really help you through this stage. Definitely ask your doctor if they're appropriate for you. Basically you stick it over the whole burn, right onto the raw parts, then it will soak up the fluid that leaks out naturally, slowly swelling up. They're totally waterproof, don't come off easily, give a good layer of physical protection as well as protect against infection, stop the skin becoming too wet while also preventing it from drying out, and really help reduce the pain in general. You wouldn't need to avoid the beach at all for example. Then, when it has sucked up enough liquid and it's time to change it, the plaster will peel right off the now-healing flesh (it's no longer stuck to the damaged parts) with no pain or fuss. Quick rinse and air dry and on with the next dressing. I generally change them every one or two days when I have large deep blisters. Plus there's a good amount of research showing they speed healing. There are times when such a dressing isn't a good idea and second degree burns shouldn't really be messed around with in general, so talk to your Dr before you decide which dressings to buy, but go for these if you can.

My husband is really concerned by recent research on the dangers of acetaminophen

If he has a relevant biology PhD then he should also understand how it's the dangers of overdose, even small ones, which are currently under discussion, not of taking the recommended dose which has been shown repeatedly to be safe. You do not need to avoid acetaminophen as long as you have no other reason why it's contraindicated and you stick rigidly to the recommended dose or even a bit below. Trying to tell a Dr that it's dangerous at any dose might actually give you problems because it makes you look pretty uninformed so they ignore your opinion altogether. Avoid it if you want to, that's fine, just don't get too caught up with debating the reasons with the Dr.
posted by shelleycat at 5:39 AM on December 14, 2013 [8 favorites]

Oh also: given that prevention of infection really is the main issue with burns like this, rubbing non-sterile plant gunk or lotion or ointment or whatever other home remedies people like into the circulation-compromised tissue of your burn is a bad idea. The burn damaged the blood flow - and thus reduced the supply of immune cells to deal with possible pathogens in that area - while also damaging the barrier that keeps those pathogens out (i.e. your skin). Clean it appropriately, cover it with appropriate dressings to keep it clean, and let it heal.

Last time I had a burn deep enough to blister into the lower layers of my skin it was healed in a week or so with the hydrocolloid dressings and left no scar. Use modern technology as much as you can here, it's really great!
posted by shelleycat at 5:49 AM on December 14, 2013 [6 favorites]

An urgent care appointment with a doctor who has never seen you before is not the time to be making pop science demands about pain meds. The amount of acetaminophen combined with prescription painkillers is only enough to be dangerous if a) you take it with alcohol and/or b) you take an overdose and/or c) you combine it with other products containing acetaminophen (this is the same as option b). Urgent care sees a lot of drug seekers and if I were you -- in legitimate pain -- I would not run the risk of seeming like one of them. It's typical for drug seekers to use a medical/scientific sounding excuse to try to steer the prescribing physician ("I'm allergic to everything but Dilaudid" is just the tip of the iceberg).
posted by telegraph at 7:06 AM on December 14, 2013 [4 favorites]

My husband had a bad oil burn on his hand about 10 days ago that is finally healing. He put antiseptic cream on it and a piece of gauze much larger than the burn and taped it down over it, then changed it. The first few days, he changed the gauze 3-4 times a day, as it seeped through, and now he changes it once a day, but it's patched over and dry.

You need lots of plain clean gauze, not-super-sticky surgical tape (you don't want to rip off skin with super sticky tape) and a big tube or two of antiseptic cream. Change it often, keep it scrupulously clean. His went sort of dark-brown and dried out on the outside of the burn, then pink and raw in the middle.

The worst was accidentally bumping it which would cause shocks of pain. On your foot - I would definitely try on shoes/slippers and work out what you can wear without causing pain, plus try really thick socks for padding.
posted by viggorlijah at 7:59 AM on December 14, 2013

Oh, and no swimming in the sea until it is completely scabbed over. Even warm-hot water was painful, and salt water would be excruciating. He only needed ibuprofen for general pain for the first day, by the second it was fine as long as it wasn't directly pressed.
posted by viggorlijah at 8:00 AM on December 14, 2013

I dumped out a casserole dish of bacon fat and chicken juice, fresh from the oven, onto my foot several years ago. My pain peaked in the first 12 hours, and a couple of days later I realized that while I was terrified of something touching/hurting it...I didn't actually have much feeling left*. But the surprise of realizing that made me also realize I had been kind of stunned and out of it for days - I was very definitely recovering from a serious insult and my resources were diverted.

*Though I was so protective of my foot that I never tested how sensitive it might be. My dogs basically weren't allowed in the same time zone as me. I managed to never drop anything on it, didn't let shower water hit it directly, and refused to poke it. But when I'd change dressings I did not have much sensation.

I used the gel pads religiously for about 8 days. I had nothing more than a vague cool sensation when putting on and removing them. I really should have gone to a doctor, but by the time I snapped out of my daze I was starting to heal.

My Target and CVS never had more than 1-2 packs of those burn gel pads on the shelves at a time for some reason. If you decide to stock up on them, be smarter than me and ask if they have more in the back.
posted by Lyn Never at 8:18 AM on December 14, 2013

When I had an open blister from a second degree burn, I was prescribed silver nitrate cream and two Vicodin. Two vicodin was enough to get me through the acute pain phase, and the silver nitrate prevented any infection.
posted by KathrynT at 9:56 AM on December 14, 2013

I got a pretty ghastly steam burn on the inside of my thigh about 6 weeks ago that I treated in all the wrong ways (ice immediately after, constant poking at it with dirty fingers, clawing it bloody in my sleep, hot baths, etc.) and my only treatment was changing the bandages 2x a day, neosporin, and bactine at night to deal with the healing itch. The thumb-sized burn has healed completely to a pencil-eraser-sized shiny pink spot, although the areas around it where I unfortunately used latex bandaids is still a little funky from the gross inflammation where I had an allergic reaction to them.

The very worst pain was immediately afterwards and for the rest of that night - it felt like the entire inside of my thigh was badly burned, and I couldn't sleep without half a percoset. The next day it was dialed down but still pretty intense - putting any weight on my leg was really uncomfortable, and doing anything that flexed my quads (so everything, basically) was like being stabbed in the leg. That faded by day 2 to a low ache. The deep unscratchable healing itch set in by day 3-4; that was far worse than the pain, tbh.
posted by elizardbits at 9:58 AM on December 14, 2013

On my phone and can't link, sorry, but Google 3M Tegaderm transparent dressings. They let skin breathe but keep water out, they are a thin film one scarcely notices, they stay put wonderfully but don't hurt to remove. Really amazing product. They can also be used to hold other dressings in place.
posted by kmennie at 10:22 AM on December 14, 2013 [1 favorite]

Take Bag Balm with you and apply it liberally as soon as you can stand to touch the burn. You'll be amazed at how well it helps heal your burns and soothes the pain, while keeping secondary infections to a minimum.
posted by Lynsey at 10:40 AM on December 14, 2013

For my recent hand burn (large blisters but they remained closed), the thing that helped me most is 2nd Skin Moist Burn Pads.

They are sterile and made out of water (in a sort of jello-like form), so they keep the burn cool and moist and relieve a significant amount of the pain (and can stay on all day, unlike an ice pack). They have no adhesive, so you will need tape or self-adhesive gauze to hold them on. I recommend buying a lot of them as you will never want to take them off.

FYI, I spent a lot of time calling pharmacies asking if they had 2nd Skin, and being told no, but then when I actually went to the pharmacy I saw they DID have them but under a generic store name, so be sure to ask for them just as moist burn pads as well.

In terms of the pain, the worst was the first 12 hours or so. After a couple of days it was quite tolerable as long as I kept anything from bumping it and kept the burn pads on.
posted by unsub at 10:55 AM on December 14, 2013

Response by poster: Thank you everybody! It turned out the pain ramped down so much I didn't even need to ask the doc for any rx painkillers. The 2nd to 5th hours after the burn were like UNBELIEVABLE MIND-ALTERING PAIN and now it's already so much better that it's not really taking any of my mental focus and I'm okay managing it with ibuprofen.

The prescriptions I got were silver sulfadiazine (cream with topical anesthetic & antibiotic) and as wjm predicted, an oral antibiotic to take only if I notice any signs of infection.
posted by kalapierson at 2:17 PM on December 14, 2013

Response by poster: As the doc warned was likely with open blisters, these did get infected and plenty painful again. They're healing, slowly. (And I had a systemic allergic reaction to the antibiotic -- really not my month :)).

Something I wish I'd known about: these dressings, very highly recommended but pointed out to me too late. (Doc says she'd happily have tried them at the beginning but doesn't want me trying them after an infected wound.)

Thanks to all for the help!
posted by kalapierson at 5:31 AM on December 24, 2013

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