Objectives: This study was designed to investigate the effect on skin temperature of different methods of use of a hydrogel dressing. Methods: Twelve volunteers had temperature measured under a hydrogel dressing with different combinations of air movement and bandaging. Results: A large drop in skin temperature was only achieved when the dressing was left exposed with air movement over the surface of the dressing. Conclusions: A temperature that gives effective analgesia is not reached if the dressing is used in accordance with the manufacturer's instructions (covered with an insulating layer). This explains the authors' observation that paramedics and patients often leave these dressings uncovered. B urns are common injuries, but their management can be complex 1 and there are scarce data to define optimal initial treatment. A hydrogel dressing (Waterjel) is commonly used by ambulance service personnel in the prehospital treatment of a burn.2 These dressings are non-adherent and are available in sizes ranging up to a "whole body" sheet. Analgesia is provided by cooling 3 from evaporation of water and volatile substances. The manufacturer recommends that the dressing is covered, however we have observed that patients often arrive in the accident and emergency (A&E) department with these dressings uncovered. We therefore investigated the effect of different methods of use of a hydrogel dressing on skin temperature. METHODSThe sample size was calculated assuming a clinically significant difference of 4°degrees (the difference between normal skin temperature and the analgesic threshold of 28°) using a β value of 0.9 and an α value of 0.05. Ethics committee approval was obtained. Twelve normal volunteers were studied in a temperature controlled laboratory. Skin temperatures were measured on the dorsal surface of both forearms, with one arm being tested and the other being used as a control.The skin temperature was recorded for 15 minutes before the application of the dressing, for 20 minutes with the dressing in place, and then for five minutes after removal of the dressing (20 minutes approximates to the transport time to hospital). The combinations of dressings studied were: (1) Hydrogel dressing alone (2) Hydrogel dressing wrapped in a thick bandage (3) Hydrogel dressing with air movement (4) Hydrogel dressing wrapped in thick bandage with air movement Air movement was created by a desktop fan at a standard distance and setting. These combinations were used to re-create conditions commonly found in the prehospital care of patients with burns. RESULTSThe pattern of change of skin temperature with time under each of the dressings is shown in figure 1. On initial application all dressing combinations cooled the skin to give some analgesia, however only one of the conditions (airflow over the dressing with no bandage) resulted in a skin temperature low enough to give analgesia throughout. With air movement over the area, there was a large additional drop in skin temperature after removal of the dressing. DISCUSSIONIt...

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has proved as successful as I hoped, and her former condition of miserable deformity is so much mitigated, that she will be able to get her own living as a domestic servant." Since then, I have seen her every now and then, and have ,been gratified at the gradual improvement which has taken place in her appearance. The flaps on the sides of the neck have become much wider, and she has now at least three inches of sound integument in the vertical direction on each side. The colour and puckered appearance of the cicatrices have also in a good measure disappeared, and the band in front interferes very little with the movements of the head and jaw. REPORT OF A SINGULARLY COMPLICATED CASE. CONVULSIONS. DELIVERY BY TURNING. JAUNDICE AFTER TAKING CHLORIDE OF LIME BY MISTAKE. GRAPE DIET. RECOVERY.

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