What is the most effective method to decrease the zone of stasis in a patient with an electrical injury?

Controlling Temperature is Most Effective for Decreasing the Zone of Stasis in Electrical Burns

Controlling temperature by cooling thermal burns with cold (15° to 25°C) tap water as soon as possible is the most effective method to decrease the zone of stasis in a patient with an electrical injury. 1

Understanding Zones of Injury in Electrical Burns

Electrical burns create three distinct zones of tissue damage:

• Zone of coagulation: central area with complete cell death
• Zone of stasis: surrounding area with compromised blood flow but initially viable cells
• Zone of hyperemia: outermost area with increased blood flow

The zone of stasis is critical because it can either recover or progress to necrosis within 24-48 hours after injury, depending on treatment.

Evidence-Based Management to Reduce Zone of Stasis

Temperature Control (Most Effective)

• Cool thermal burns with cold (15° to 25°C) tap water as soon as possible 1
• Continue cooling until pain is relieved
• Cooling reduces:
  • Pain
  • Edema
  • Depth of injury
  • Need for excision and grafting

Important Cautions

• Do not apply ice directly to a burn; it can produce tissue ischemia 1
• Avoid prolonged cold exposure to small burns or brief exposure to large burns as this can cause further tissue injury and hypothermia 1

Other Interventions with Supporting Evidence

Recent research has shown several promising approaches for decreasing the zone of stasis:

1. N-Acetylcysteine (NAC): A 2018 study demonstrated that oral NAC significantly decreased tissue destruction in electrical burns by reducing the necrotic area and serum creatine kinase levels 2

2. Subatmospheric Pressure (Vacuum-Assisted Closure): Application of controlled negative pressure (125 mmHg) within 12 hours of injury significantly decreased the maximum depth of cellular death in partial-thickness burns 3

3. Glutathione: Systemic administration has shown effectiveness in saving the zone of stasis by increasing cellular thermo-resistance 4

Clinical Approach to Electrical Burns

1. First ensure safety by turning off the power source 1

2. Assess the victim for:

   • Entry and exit points of current
   • Thermal burns from burning clothing
   • Need for CPR or defibrillation
   • Signs of shock

3. Apply appropriate temperature control:

   • Cool burns with cold tap water (15-25°C)
   • Avoid ice application
   • Monitor for hypothermia

4. All electrical burn victims require medical assessment as the extent of injury may not be apparent 1

Common Pitfalls to Avoid

• Using ice directly on burns (causes tissue ischemia)
• Delaying cooling (reduces effectiveness)
• Underestimating the extent of internal damage in electrical injuries
• Failing to recognize that electrical burns often cause more severe tissue damage than is apparent on the surface
• Not monitoring for cardiac arrhythmias, which can occur with electrical injuries

Temperature control through appropriate cooling remains the most evidence-based intervention for decreasing the zone of stasis in electrical burns, with promising adjunctive therapies emerging in recent research.