Which finding is most concerning in a patient with significant burns?

In a patient with significant burns, finding a dry cough and a hoarse voice is particularly concerning as it may indicate inhalation injury. The presence of respiratory symptoms suggests that the patient could be experiencing damage to the airway or lungs due to the inhalation of smoke or hot gases. This type of injury can significantly complicate the patient's condition and lead to respiratory distress, which may require immediate intervention.

Burns typically affect the skin and surrounding tissues, but inhalation injuries can lead to life-threatening complications. Symptoms like a dry cough and hoarseness reflect potential edema and inflammation in the upper airway, indicating that the airway may be compromised. In severe instances, this can lead to airway obstruction, making it crucial to assess and manage the patient's airway promptly.

Other findings listed, such as severe blisters on the hands or clothes adhered to burned skin, are significant but primarily related to the management of the burn wounds and overall skin integrity rather than an immediate threat to the airway. A closed deformity of the wrist does suggest a need for orthopedic evaluation and possibly surgical intervention, but it does not indicate an acute risk to the patient's respiratory status like the cough and hoarseness do. Thus, the finding of a dry cough and a hoarse voice stands out