the anterolateral aspect of the right thigh of 3% body surface area. The skin was erythematous and oedematous but not blistering and was treated conservatively. The wound healed within three weeks, and he was discharged with no further treatment. Comment Industrial and domestic use of liquid propane is increasing. Liquid propane is volatile; the boiling point at atmospheric pressure is-44°C. The gas is usually transported as a liquid under pressure at-64°C. The catastrophic consequences of igniting liquid propane have been reported.' Injuries occasionally occur in the industry, but injuries from direct contact with propane are rarely seen. Spraying liquid propane on to the skin usually causes cold injury. Hicks et al showed that spraying the skin with propane for 12 seconds caused epidermal necrosis in animals.) Spraying for 30 seconds caused dermal necrosis 24 hours later, and damage to the superficial muscle was seen five days later. The tissue freezes, which leads to cell damage and vascular thrombosis-similar to frostbite but more rapid with propane.

Summary The location of care for many brain‐injured patients has changed since 2012 following the development of major trauma centres. Advances in management of ischaemic stroke have led to the urgent transfer of many more patients. The basis of care has remained largely unchanged, however, with emphasis on maintaining adequate cerebral perfusion as the key to preventing secondary injury. Organisational aspects and training for transfers are highlighted, and we have included an expanded section on paediatric transfers. We have also provided a table with suggested blood pressure parameters for the common types of brain injury but acknowledge that there is little evidence for many of our recommendations. These guidelines remain a mix of evidence‐based and consensus‐based statements. We have received assistance from many organisations representing clinicians who care for these patients, and we believe our views represent the best of current thinking and opinion. We encourage departments to review their own practice using our suggestions for audit and quality improvement.

Patients frequently leave hospital uninformed about the details of their hospital stay with studies showing that only 59.9% of patients are able to accurately state their diagnosis and ongoing management after discharge. 1 2 This places patients at a higher risk of complications. Educating patients by providing them with accurate and understandable information enables them to take greater control, potentially reducing readmission rates, and unplanned visits to secondary services whilst providing safer care and improving patient satisfaction. 3 4We wished to investigate whether through a simple intervention, we could improve the understanding and retention of key pieces of clinical information in those patients recently admitted to hospital.A leaflet was designed to trigger patients to ask questions about key aspects of their stay. This was then given to inpatients who were interviewed two weeks later using telephone follow up to assess their understanding of their hospital admission. Patients were asked about their diagnosis, new medications, likely complications, follow up arrangements and recommended points of contact in case of difficulty. Sequential modifications were made using PDSA cycles to maximise the impact and benefit of the process.Baseline data revealed that only 77% of patients could describe their diagnosis and only 27% of patients knew details about their new medications. After the leaflet intervention these figures improved to 100% and 71% respectively.Too often patients are unaware about what happens to them whilst in hospital and are discharged unsafely and dissatisfied as a result. A simple intervention such as a leaflet prompting patients to ask questions and take responsibility for their health can make a difference in potentially increasing patient understanding and thereby reducing risk.

No abstract