What can decrease the zone of stasis in a patient with an electrical burn?

Management of Zone of Stasis in Electrical Burns

Temperature control is the key intervention to decrease the zone of stasis in electrical burn injuries. 1

Understanding the Zone of Stasis in Electrical Burns

The zone of stasis represents the area of tissue surrounding the primary burn injury where blood flow is compromised but tissue remains potentially viable. In electrical burns, this zone is particularly critical because:

• Electrical injuries cause progressive tissue destruction through small vessel occlusion and elevated arachidonic acid levels in areas of greatest heat production 2
• The tissue damage extends far beyond visible skin injury, with deep muscle and periosseous tissue particularly vulnerable 2
• Unlike thermal burns, electrical injuries create extensive local destruction at entrance and exit points with ongoing tissue loss 2

Why Temperature Control is the Answer

Cooling the burn limits deepening of the injury and reduces the zone of stasis. 1 The mechanism works through:

• Limiting progressive tissue destruction by reducing metabolic demands in the zone of stasis 1
• Decreasing inflammation and capillary leakage that contribute to tissue hypoperfusion 1
• Reducing pain, which itself can worsen tissue perfusion through sympathetic activation 1

Evidence-Based Cooling Protocol

For burns with total body surface area <20% in adults and <10% in children without shock, cooling should be performed 1:

• Cool with tap water at 15-25°C for at least until pain is relieved, ideally within 30 minutes of injury 3
• Cooling times of less than 40 minutes significantly reduce the need for skin grafting (P < 0.001) 1
• Never apply ice directly, as this causes tissue ischemia and increases tissue damage 3

Why Peripheral Vasodilation is Not the Answer

Peripheral vasodilation would theoretically worsen outcomes in electrical burns because:

• Aggressive fluid resuscitation is already required to maintain adequate circulatory volume and urine output of 100 ml/hour 2
• Vasodilators would exacerbate hypotension and compromise perfusion to already ischemic tissue 2
• The primary problem is microvascular thrombosis and vessel occlusion, not vasoconstriction 2

Critical Additional Management Considerations

Beyond temperature control, electrical burn management requires:

• Aggressive fluid resuscitation with crystalloid isotonic fluids (0.9% saline) to maintain normal vital signs and urine output of 100 ml/hour 4, 2
• This high urine output target overcomes the destructive renal tubular effects of myoglobin and hemoglobin products 2
• Early surgical decompression and debridement of nonviable tissue, particularly periosseous muscle 2, 5
• Continuous cardiac monitoring due to risk of arrhythmias including ventricular fibrillation and asystole 4

Common Pitfalls to Avoid

• Do not underestimate injury severity based on visible skin damage alone 4
• Electrical burns cause extensive deep tissue destruction that is not apparent on initial examination 2
• Do not delay cooling—it must be initiated within 30 minutes of injury for maximum benefit 3
• Avoid cooling large burns without ability to monitor core temperature due to hypothermia risk 3
• Do not under-resuscitate—electrical burns require more aggressive fluid management than thermal burns of similar surface area 2