Medical Monday 2 Dec 2019

Another week and another month! I hope everyone had a great Thanksgiving and hopefully the holiday season is stress and injury free for everyone. This week we are going to be talking about blisters! Everyone has probably dealt with blisters in one way or another. Whether it be from burns due to cooking, or from hiking, blisters can be a miserable issue to deal with. If left untreated they can lead to infection which can be very dangerous even in a grid up situation.

Blister can be caused by many different things. Ranging from friction, heat, chemical reactions, and even allergies. The main ones we are going to look at today are ones caused my friction and those related to burns.

Friction blisters are some of the most common injuries seen in a military setting with light troops. Hiking long distance with heavy weight in any kind of climate can cause blisters, specially if someone doesn’t know how to properly care for their feet. Boots that are too tight can cause friction points on your foot, or boots that are too loose can allow your feet to slip around and cause massive blisters. Wet feet can be an issue all its own or can compound one of the previously mentioned causes. Make sure your boots are properly broken in before you step off to help prevent blisters from forming. Proper socks are also crucial. Most people, myself included, swear by wool socks. A big plus is to add very thin liner socks. An old grunt trick was to wear nylon or silk pantyhose or leggings underneath their issued socks. The liner sock will wick moisture away from your feet and to the wool sock. It will also let the friction be between the liner sock and the outer sock, instead of between your foot and the wool sock. Changing your socks after a long ruck is key to bringing your feet back down to a regular moisture level, more so if you had to cross any body of water. Dry feet do not blister hardly at all compared to wet feet, which is why the liner socks are so helpful. Sometimes crossing water is unavoidable and you won’t have the ability to change your socks at regular time intervals. Or you’ll have to chop more wood than you expected. You will end up with a blister. How to you take care of it? Well it all depends on when you catch it, and what it looks like when you do catch it.

Before the blister forms you will end up with a hot spot. A hot spot is just a reddened area of skin that will be tender to the touch and in an area where friction has been occurring. You will treat this with a donut of moleskin. Just cut a circle of moleskin about a 1/4th of an inch (6 mm for those of you still stuck on the metric system) bigger than the hot spot itself and then cut a hole inside the size of the edges of the hot spot. Slap on enough of these to prevent the hot spot from getting rubbed, and keep hiking.

If you don’t take care of a hotspot a blister will form. A blister is a pocket of fluid between the upper and lower layers of the skin. The fluid should be clear, if it is bloody that means that capillaries underneath the skin have been damaged. If it looks like puss then you have an infection and it’s not a new blister. Try to avoid draining these at all costs. If you have to drain a blister clean the skin and your hands with soap, disinfect a very sharp needle with alcohol (or use a very small hypodermic needle) and go in at the base of the blister with the needle level with the surrounding skin. Do not remove the skin covering the blister as it acts as a natural barrier to prevent infection. Once all of the fluid has been drained clean the area again and apply a topical antibiotic cream. Cover the blister with gauze and tape around the edges completely. A bandaid that mimics this would work depending on the size of the blister.

If the roof of the blister (the skin that covers the fluid) has been partially torn you will need to clean out the exposed area and make sure that no debris got stuck under the remaining skin. Try not to remove any of the remaining skin if you can. Dakin’s solution (talked about last week) would work well for the cleaning. Once it has been cleaned apply a non adherent dressing over the blister and tape it in place. Do not place tape directly over any blister as that will stick to the top layer of skin and rip it off when you go to change it. Use moleskin to protect the dressing and blister from further damage.

If the roof of the blister has completely been removed then clean all of the exposed skin with Dakin’s solution and apply a hydrocolloid dressing. A hydrocolloid dressing contains a gel forming material with gelatin that will absorb the fluids that will seep out of the now exposed skin. They are backed with a waterproof material that prevents that that fluid from evaporating. This keeps the moisture on the skin which encourages proper healing, decreases pain, and prevents any new tissue from being ripped off when you change the dressing. These are only for blisters where the entire roof has been removed. You would want to cover this as well with moleskin if you have to keep walking.

If the blister was caused by a burn you first want to treat the burn, reference https://stuckpigmedical.com/2019/11/20/medical-wednesday-20-nov-2019/ for burn treatment. Then treat the blisters. Leaving these blisters intact is more important because the surrounding skin is already prone to infection. Moleskin isn’t necessary on these blisters since they aren’t caused by friction. But situations are unique, so if it is needed then use it.

If you haven’t noticed by now, prevention is the best treatment for any injury, which is why I always talk about it on every post. Blisters are preventable, but not always. Pay attention to what your body is telling you, and make sure your footwear is broken in before you attempt to use them in a situation that matters. Get training! Don’t be left out in the woods bleeding like a stuck pig!

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