What approach is recommended to decrease the zone of stasis in a patient with an electrical burn?

Temperature Control Decreases the Zone of Stasis in Electrical Burns

The correct answer is B: Control temperature—this is the intervention that decreases the zone of stasis in electrical burn injuries, not peripheral vasodilation. 1

Why Temperature Control Works

Active cooling prevents coagulum formation and reduces ongoing thermal injury at the tissue level, which is the fundamental mechanism by which the zone of stasis is reduced in electrical burns. 1 The zone of stasis represents tissue that is potentially salvageable but at risk of progressive necrosis if not properly managed.

Mechanisms of Benefit

• Temperature-controlled interventions prevent heating-induced tissue destruction by actively cooling the electrode-tissue interface and preventing intraluminal stasis. 1

• Hyperthermia worsens outcomes in all forms of tissue injury, including electrical burns, by accelerating cellular damage and metabolic dysfunction. 1 Avoiding hyperthermia in the post-injury period is crucial as elevated temperature accelerates tissue destruction.

• Active cooling interrupts the cascade of progressive tissue damage that occurs in the zone of stasis, where cells are injured but not immediately dead.

Why Not Peripheral Vasodilation

Peripheral vasodilation is NOT the recommended intervention for decreasing the zone of stasis. 1 Instead, the focus should be on:

• Aggressive IV crystalloid resuscitation with 0.9% saline (not vasodilators) to counteract shock and facilitate excretion of tissue breakdown products. 1

• Rapid IV fluid administration to ensure adequate tissue perfusion and prevent further damage through maintaining adequate blood flow. 2, 1

Practical Management Algorithm

Immediate Actions:

1. Ensure scene safety by turning off the power source before approaching the victim. 2
2. Initiate crystalloid isotonic fluids (0.9% saline) as first-line therapy for patients showing signs of shock. 2
3. Implement temperature control measures to prevent ongoing thermal injury and reduce the zone of stasis. 1

Fluid Resuscitation Protocol:

• Use fluid challenge technique with boluses of 250-1000 ml, reevaluating after each bolus. 2
• Monitor lactate levels, aiming for 20% reduction in the first hour. 2
• Consider vasopressors (norepinephrine) only if hypotension persists despite adequate fluid resuscitation. 2

Critical Monitoring:

• Cardiac monitoring is essential due to risk of arrhythmias including ventricular fibrillation, ventricular asystole, and ventricular tachycardia. 2
• Early intubation should be considered for patients with extensive burns involving the face, mouth, or anterior neck. 2

Common Pitfalls to Avoid

• Do not underestimate injury severity based on visible skin damage alone—electrical injuries often cause extensive internal tissue damage not apparent on surface examination. 2

• Avoid hypotonic solutions like lactated Ringer's, which can increase tissue edema in electrical injury patients. 2

• Do not use peripheral vasodilators as the primary intervention for zone of stasis reduction—this is a common misconception. 1