On admission to the emergency department the burned client’s blood pressure is 90/60, with an apical pulse rate of 122. These findings are an expected result of what thermal injury-related response?
A. Fluid shift
B. Intense pain
C. Hemorrhage
D. Carbon monoxide poisoning
Correct Answer: A. Fluid shift
The physiologic effect of histamine release in injured tissues is a loss of vascular volume to the interstitial space, with a resulting decrease in blood pressure. After a burn, fluid shifts from vascular to interstitial and intracellular spaces because of increased capillary pressure, increased capillary and venular permeability, decreased interstitial hydrostatic pressure, chemical inflammatory mediators, and increased interstitial protein retention.
Option B: Intense pain and carbon monoxide poisoning increase blood pressure. Superficial dermal burns are initially the most painful. Even the slightest change in the air currents moving past the exposed superficial dermis causes a patient to experience excruciating pain. Without the protective covering of the epidermis, nerve endings are sensitized and exposed to stimulation.
Option C: Hemorrhage is unusual in a burn injury. The difference with a burn is the heat actually stops the blood from flowing. A small bit of blood may ooze out at first, but it won’t actually bleed much.
Option D: Most commonly, patients with carbon monoxide poisoning will present with headache (more than 90%), dizziness, weakness, and nausea. Patients may be tachycardic and tachypneic. They may exhibit hypotension. Mental status changes such as confusion, altered level of consciousness, disorientation, and memory loss may occur.
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