What decreases the zone of stasis in a patient with an electrical injury?

Management of Zone of Stasis in Electrical Burn Injuries

Controlling temperature by applying cold water (15° to 25°C) is the most effective intervention to decrease the zone of stasis in electrical burn injuries. 1

Understanding Electrical Burns and the Zone of Stasis

Electrical burns involve three concentric zones of tissue damage:

• Zone of coagulation (central, irreversibly damaged tissue)
• Zone of stasis (surrounding area with compromised blood flow that can be salvaged)
• Zone of hyperemia (outermost area with increased blood flow)

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

Evidence-Based Management Approach

First-Line Intervention: Temperature Control

1. Apply cold tap water (15° to 25°C) to the burn site as soon as possible after ensuring the electrical source is disconnected 1

   • Continue cooling until pain is relieved
   • This reduces edema, pain, and depth of injury
   • Speeds healing and may reduce need for excision and grafting

2. Important cautions with cooling:

   • Do NOT apply ice directly to the burn as it can cause tissue ischemia
   • Avoid prolonged cold exposure to small burns or brief exposure to large burns as this can cause further tissue injury and hypothermia
   • Monitor for signs of hypothermia, especially in patients with extensive burns

Additional Management Considerations

After ensuring safety and initiating cooling:

1. Assess for associated injuries:

   • Cardiac arrhythmias (may require ECG monitoring)
   • Respiratory compromise
   • Cervical spine injuries
   • Entry and exit point burns

2. Fluid resuscitation:

   • Rapid IV fluid administration is indicated for patients with significant tissue destruction
   • Maintain adequate diuresis to facilitate excretion of myoglobin and other byproducts of tissue destruction 1

3. Wound care:

   • Leave burn blisters intact and cover loosely with sterile dressing 1
   • Consider early intubation for patients with facial, mouth, or neck burns due to risk of rapid soft-tissue swelling 1

Research on Zone of Stasis Preservation

Several experimental treatments have shown promise in preserving the zone of stasis, though they are not yet standard clinical practice:

• N-acetylcysteine has demonstrated effectiveness in reducing tissue destruction in electrical burns 2
• Subatmospheric pressure therapy applied within 12 hours of injury has shown benefit in preventing progression of partial-thickness burns 3
• Activated protein C improved tissue perfusion and decreased necrosis in experimental models 4

Key Points to Remember

• The primary intervention that decreases the zone of stasis is controlling temperature with appropriate cooling
• Safety first: ensure power source is disconnected before touching the patient
• All electrical burn victims require medical assessment as the extent of injury may not be apparent
• The window for intervention to save the zone of stasis is typically within the first 12-24 hours after injury

By promptly applying appropriate temperature control through cooling with tap water (not ice), you can significantly reduce the progression of tissue damage in the zone of stasis, improving outcomes for patients with electrical burns.