[Uncertain Acute Hemodynamic Instability after Severe Burn Injury: an (Un-)Usual Complication]

First aid and treatment of burn patients pose a challenge to responsible physicians. Primary assessment should include an evaluation of the degree and extent of the burn injuries as well as a physical examination for other trauma injuries and trauma caused by the inhalation of toxic agents. One should focus on removal of the burning source, preservation of body temperature, sterile coverage of the burnt areas, pain management and sufficient hemodynamic stabilization. Grade IIb and more severe burns are most likely subject to surgical intervention to assure sufficient healing. Our case report illustrates a burn patient's initial treatment and clinical course, which includes the development of an acute pulmonary embolism with severe hemodynamic instability. As other critically ill patients, burn patients are at particular risk for complications like infections or other causes for hemodynamic instability. Every cardiovascular event is possibly suspicious for acute pulmonary arterial embolism (PAE). A high or increasing gap between expiratory and arterial CO₂ tension accompanied by typical symptoms like tachycardia and hypotension or respiratory distress may be caused by PAE. An echocardiogram can provide information about possible pathophysiological changes typical for PAE, nevertheless, CT-angiography is today's clinical gold standard for the diagnosis of PAE. As therapeutic measures, heparin should be administered, and thrombolysis should be considered in case of persisting hemodynamic instability, attentively taking possible contraindications into account.