Following injury, your wrist may be swollen, bruised and painful due to the overstretching of the soft tissues such as ligaments, tendons or muscles. This is often called a sprain and it is a common injury. In order to help the natural healing process, follow the advice below.

During the first 24-72 hours

• It is important to rest and elevate the wrist as much as possible to prevent further swelling. Rest with the arm elevated on pillows, ideally with your wrist above the level of your heart.
• Use over the counter pain killers as needed.
• To relieve the pain and swelling, apply a packet of frozen peas or crushed ice in a damp tea towel to the painful area. For maximum effect, apply for up to 20 minutes, every 2 hours. Cold can burn, so remove if uncomfortable.
• You may have been provided with a splint. This can be worn to support the wrist while the ligaments are healing and enable you to use the arm more comfortably. It can be removed when resting, washing or at night.
• Check that your shoulder, elbow and fingers/thumb are moving fully.
• Once the pain and swelling begin to ease, start gently moving the wrist and hand to prevent stiffness. Move into discomfort but not pain.

After 3 days

If you have not already started to move your wrist, then it is now essential that you do so to prevent future stiffness.

Exercise 1

• Sitting, grasp your injured arm well above the wrist so that your palm is face down towards the floor. Slowly move the hand up as far as possible, then stretch down as far as possible.
• Repeat 10 times.

Exercise 2

• In the same position as above, move the hand towards the thumb side of the wrist and then towards the little finger side.
• Repeat 10 times.

Exercise 3

• Combine the above movements and move the wrist in as large a circle as possible.
• Repeat 10 times.

Exercise 4

• Tuck your elbow into your side, turn your palm up and then down. Move as far as possible in each direction.
• Repeat 10 times.

For the hand

Exercise 5

• Make a tight fist with your fingers and then stretch the fingers out as far as possible.
• Repeat 10 times.

Exercise 6

• With your palm facing upwards, stretch your thumb across toward the base of the little finger. Then stretch out to the side as far as possible.
• Repeat 10 times.

Exercise 7

• Continue moving the thumb around in circles, stretching as far as possible.
• Repeat 10 times.

As each day goes by, you should be able to move the wrist more freely and with lessening discomfort. The amount of movement should eventually be the same as that on your unaffected side. Start returning to light activities, steadily building up the daily use and progressing to more demanding activities. It may be some weeks before full strength returns. Depending on how badly your wrist is sprained, it may take between 4 - 12 weeks to recover, sometimes longer.

For those returning to sport

This should not be resumed until the wrist is free of pain, supple and strong. For those sports that directly involve the wrist, it is important to ‘warm up’ first (exercises 1 - 7 may be used). Then gradually build up sporting activity and strength.

The injury may take longer to heal if you suffer from diabetes or if you smoke.

For advice on stopping smoking please visit www.nhs.uk/smokefree or discuss this with your GP.

If you are concerned about your progress, contact your GP.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002263

What is a mallet finger?

A mallet finger is caused by rupture of the tendon to the tip of the finger. Sometimes, the tendon may pull off its bony attachment. As a result, you are unable to straighten your finger tip on its own, although it can be pushed straight. Unsupported, the finger tip will have a characteristic ‘droop’. In most cases, it is not painful, but more of a nuisance.

Sometimes if the mallet finger has been caused by a sports injury, the end of your finger may well be painful, red and swollen.

How is the mallet finger treated?

Your finger is placed in a special plastic splint holding the tip straight for 6 - 8 weeks. During this time, the finger tip must be kept straight at all times, so healing can take place. It is essential that you carefully follow the instructions given to allow healing.

Your splint

• Your splint should be a comfortable fit, not too tight or loose. If it becomes loose, then you should return to us for a better fitting splint.
• The splint holds the tip joint straight, but should allow full movement of the middle joint of the finger to avoid it stiffening.
• You must ensure that the finger stays dry within the splint, which is not an easy task! Use a large protective rubber glove. Should your finger get wet inside the splint, then you will need to remove the splint and dry it and your finger.
• Each time you remove the splint you increase the risk of bending your finger and re-damaging the healing tendon. So, only remove it when absolutely necessary like when the finger and splint need cleaning or if they get wet.

When removing the splint

It is essential to follow the instructions below and it is helpful if you have someone else around when you do it.

• First, place your hand on a flat, firm surface i.e. a table.
• Loosen the tape and gently remove the splint keeping your finger flat on the table.
• Wash the top and sides of your finger with soap and water. To get underneath you can lift the finger up on its tip (maintaining the straight position).
• Dry the finger thoroughly.
• The splint will also need cleaning, but it is easier if someone does this for you.
• Carefully slide the splint back into place without allowing any bend, re-tape and secure. Make sure that the tape does not restrict the movement of the middle joint of the finger.

You will soon get used to this routine and it should be followed for the full 8 weeks.

After the 8 week

You will re-attend and be given further guidance and instructions. The splint will be removed leaving a stiff, but straighter fingertip. In some cases, the healed finger will have a residual ‘droop’ to the tip.

It may take several months for your finger to fully recover its function. Any redness, swelling and tenderness of your skin over the end of your finger may persist for the first few months after the injury. These symptoms will usually improve.

In summary

• Keep your splint on.
• Keep your fingertip straight.
• Keep it dry.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002261.

Following injury, your elbow may be swollen, bruised and painful. In order to help the natural healing process, follow the advice below.

During the first 3 days

• It is important to rest at this stage to prevent further swelling. You may have been given a sling to support the arm. If this is uncomfortable on your neck, then remove the sling when sitting and support the arm comfortably on a pillow.
• Keep your neck shoulder, wrist and hand moving. These joints are not injured but will stiffen if not kept mobile. Support your elbow and lift your arm gently up over your head.
• To relieve pain and swelling, apply a packet of frozen peas or crushed ice in a damp towel to the injured area. For maximum effect, apply for up to 20 minutes, every 2 hours. Cold can burn, so remove if uncomfortable.
• As the pain begins to settle you can begin to gently move the elbow. Movements should be performed slowly moving into mild discomfort but short of pain.

After 3 days

• If you have not already started to gently move your elbow, then it is now essential that you do so, to avoid future stiffness.

The exercises below can be repeated hourly though the day. Regaining full extension (straightening) of the elbow is important. Work up to this gradually, doing the exercises little and often will help.

1. Rest your elbow in the palm of the opposite hand, slowly bend and straighten your elbow as far as possible.
   Repeat up to 10 times.
2. Tuck your elbow into your side, turn your hand palm up then palm down. Move in each direction as far as possible.
   Repeat up to 10 times.

As each day goes by, you should be able to move the arm more freely and you can gradually discard your sling. As well as exercising your elbow, check that your neck, shoulder, wrist and hand are not stiff.

As soon as possible, resume light activities, but in the first weeks you should avoid carrying heavy objects, or doing anything that forces the elbow into a straight position. As the arm feels more comfortable, gradually build up to heavier activities.

For those returning to sport, swimming is good exercise. However, do not return to racquet or contact sports until your elbow is free of pain, supple and strong

This leaflet gives general advice only. Depending on how severely your elbow is injured, it may take between 6 - 8 weeks for you to regain full movement. Full elbow straightening is often slower to return than elbow bending and in some cases may always remain restricted.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002260.

Following injury, your shoulder may be swollen, bruised and painful due to sprained muscles, tendons and ligaments. In order to help the natural healing process, follow the advice below.

During the first 3 days

It is important to rest your arm to prevent further swelling. You may have been provided with a sling to support the arm. If so, use it.

Frozen peas or crushed ice in a damp tea towel can be applied to the painful area. For maximum effect, apply for up to 20 minutes, every 2 hours. Cold can burn, so remove if uncomfortable.

Once the worst of the pain begins to settle, it is important to start gently moving the injured arm. This may well be uncomfortable at first, but is essential to avoid future stiffness. Check that you can move your elbow, wrist and hand fully. Use your other arm to assist the movements of your injured shoulder. Move into discomfort, but short of pain.

Move your shoulder

• Forwards.
• Out to the side.
• Repeat 4 - 5 times daily.

After 3 days

You can now gradually discard your sling and progress your exercises to the following:

Exercise 1

Lean on a firm support with your uninjured arm. Allow your injured arm to hang loosely away from your body.

• Slowly swing your arm backwards and forwards alongside your body. Start with small movements and then gradually move as far as possible in each direction. Repeat for 1-2 minutes.
• Now swing across your body and out to the side as far as possible. Repeat for 1-2 minutes.
• Move the arm in a circular motion. Start with small circles increasing to larger circles. Repeat for 1-2 minutes.

Exercise 2

• Stand facing a wall, placing your hand flat against it. Slowly slide or ‘walk’ your hand up the wall as far as possible. You can use a piece of blue tack to mark your daily progress. Remember to come down the wall slowly! 
• Repeat 2-3 times.

Exercise 3

• Reach up behind your back as far as possible with your injured arm. Compare with your other arm.
• Repeat 2-3 times.

Repeat exercises 4-5 times daily and, as your arm becomes more mobile, steadily build up your level of activity.

Depending on the nature and severity of your injury, it may take between 1-3 months, sometimes longer to recover. It is advisable to continue with the exercises until full movement has returned, although in some cases some permanent loss of movement may occur.

Problems that may persist for some time include pain at night, especially if lying on the injured shoulder. Also pain/discomfort when the shoulder is put in certain positions i.e. reaching behind your back or fully over your head.

Returning to sport

Before returning to racquet or contact sport, your shoulder should be free of pain, supple and strong. Consider weight training to build up your shoulder fitness. Just be sensible and steadily build up your exercise tolerance.

© North Bristol NHS Trust. This edition published May 2024. Review due May 2027. NBT002259.

Your neck is made up of a number of bones bound together by strong discs and ligaments. It is also protected by strong muscles.

Neck sprains can involve an overstretching of the ligaments and muscles. Often symptoms may not arise for several hours or even one to two days after injury.

Common complaints include pain and stiffness in the neck, jaw, shoulders, upper back and sometimes lower back.

Headaches, nausea, dizziness, loss of concentration and tearfulness can also occur. Symptoms may last from a few days to a few weeks.

It is reassuring to know that most neck sprains are not serious and rarely result in permanent harm.

All recent research strongly advises an early return to normal activity.

This page gives general advice on how to manage your injury.

During the first 24 - 48 hours

• You may be aware of your neck becoming more stiff and painful. Depending on your level of symptoms and the type of job you do, you may need to rest and stay off work for a day or two. However, if symptoms allow, try to continue with normal daily activities. This will not cause further damage to your neck. Just be sensible and take things steady, or change the way you do them.
• Where necessary take medication to ease the symptoms. It will be most effective if taken at regular intervals.
• Either heat or cold can be used to relieve pain in the back of the neck and shoulders. Use whatever gets best results for you. A bag of frozen peas wrapped in a damp towel can be applied for up to 20 minutes. For maximum effect apply every two hours. Alternatively, you may prefer heat using a heat pad, hot water bottle (in a cover) or having a hot shower. Heat and cold can cause burns so remove if uncomfortable.
• Adopt positions that are comfortable for you, but move around frequently to prevent stiffness. Good posture is important, so avoid slumping when sitting. If necessary, place a small rolled towel or a cushion in the lower back to give support.
• When lying, you may find it helpful to alter your pillow height. A small rolled towel can be placed in the bottom edge of your pillow case, or you can tie your pillow in half (butterfly pillow) for extra support.
• Avoid sleeping on your front.

After 48 hours

It is essential to start exercising your neck and shoulders. Restoring range of movement will make everyday activities easier and less uncomfortable. Remember - movement is good for you.

The following exercises should be performed slowly and thoroughly moving into discomfort but short of pain. Before you start, make sure you are sitting up straight on a firm chair.

Exercise 1

• Sit up tall, gently tuck your chin in and lengthening the back of your neck as you do so. Relax your shoulders.
• Repeat 5 times.

Exercise 2

• Sit up tall, with the chin tucked in turn your head, looking over each shoulder in turn. Move within comfortable limits, feeling a pull or stretch but do not push into pain.
• Repeat 5 times each side.

Exercise 3

• Tilt your head to one side dropping your left ear down towards your left shoulder. Hold for a count of three and repeat to the right side. Relax your shoulders away from your ears.
• Repeat 5 times each side.

Exercise 4

• Neck Tilt: Gently drop your chin towards your chest, hold for 3 seconds and return to the start position.
• Repeat 5 times. 

Exercise 5

• Stretch up above your head as far as is comfortable with each arm in turn. Then reach up behind your back with one arm then the other.

Repeat each exercise 3 times. 

Other useful advice

• If the pain in your neck becomes worse do the exercises less frequently or a little more gently.
• Aches and twinges can last for quite a few weeks.
• Tense muscles caused by stress, poor posture or anxiety can make things feel worse, you might find controlled breathing, relaxation and dropping your shoulders away from your ears helps.
• Normal activities are good for the healing process but if things are too painful try and find alternative ways of doing things.

You can return to exercise such as swimming, cycling and gentle gym activities. However, avoid impact and contact sports until you feel fully fit, free of pain, mobile and strong.

Depending on how severely your neck is sprained it may take up to eight weeks to recover, occasionally longer.

If you are still struggling to get back to your normal level of activity after 8 weeks consult your GP.

It is quite normal to be aware of the following:

• Morning stiffness in the neck.
• Discomfort at the end of stretching movements.
• Discomfort after being in one position for some time.

All this should gradually settle as your neck recovers and strengthens.

Remember

• Rest is needed for no more than 1 - 2 days.
• After 48 hours start exercises to regain movement.
• Stay active and keep moving.
• Try and continue with normal daily activities, just modify them.
• By 8 weeks you should have returned to all of your usual activities.

Following a neck sprain injury some people can complain of dizziness, headaches, blurred vision and problems with swallowing these symptoms should only last for a short while.

See your GP if any of these symptoms don’t clear up.

Children: if symptoms persist please come back to the Emergency Department.

Warning

Stop the exercises above if any of the following consistently occur and contact your doctor.

• Pins and needles or numbness in arms or legs.
• Difficulty with balance or walking.
• Disturbed vision.
• Dizziness.
• Pain spreading into your arm.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002258.

The calf is formed by the gastocnemius and deeper soleus muscles. Together they attach to the heel via the achilles tendon, providing the ‘push off’ power when walking and running.

A calf strain involves damage to some of the muscle fibres within the belly of the muscle or where the muscle fibres join the achilles tendon.

Your body’s first response to injury is inflammation, during which your calf may become hot, swollen and painful. This inflammatory phase may last from one to several days depending on the severity of your injury.

During the first 3 days

• Avoid walking on the injured leg, use crutches or a stick if provided.
• When resting elevate the leg to discourage swelling. 
• Frozen peas or crushed ice in a damp tea towel can be applied to the injured area. For maximum effect apply for 20 minutes every 2 hours.

Once the calf feels less hot and painful, it is important to start gently exercising the injured muscle. This may be uncomfortable at first, but is essential to prevent tightness and weakness and to encourage the natural healing process.

The following exercises should be performed slowly and thoroughly, moving into some discomfort but short of pain. They can be repeated 4 – 5 times daily.

Exercise 1

Move your foot up and down at the ankle stretching as far as possible in each direction. To start with you may find it easier to do this with your knee bent. As soon as you are able, do the exercise with the knee straight to increase the stretch.

Gentle circling of the ankle can be added in. Using a towel or elastic band to assist these movements can be helpful.

Repeat 10 times.

After 3 days

As soon as you are able to put weight through the injured leg, start to get up and about more. Short walks are good for the healing muscle, but avoid long distances and standing for long periods. You may find it more comfortable in shoes with a thicker or higher heel to start with, as this will lessen the stretch on the calf. Typically people tend to walk with their foot turned outwards and in front of them, but this should improve as each day goes by.

Try and discard your crutches as soon as possible and please remember to return them to the Emergency Department or to the recycling area at the main entrance to the Brunel building. 

Later exercises

The following exercises are helpful in getting full stretch and strength back in the healing muscle.

A degree of discomfort during exercise is acceptable, but never push through pain. The exercises can be repeated 3 – 4 times daily.

Exercise 2: deep calf stretch 

Stand leaning forward on a firm surface, placing your injured leg in front with the foot flat on the floor. Lean slowly forwards allowing the knee to stretch over the foot, but keeping the heel flat on the floor. Hold at the point of tightness for up to 15 seconds, repeat 4 times. 

Exercise 3: normal calf stretch

Stand facing and leaning with your hands on a wall. With feet facing forward, place the injured leg behind with the heel to the floor and the knee straight.

Stretch to the point of discomfort or tightness and hold for 15 seconds, repeat 4 times. 

Compare the stretch with your uninjured leg, they should eventually be the same.

Exercise 4: to improve strength

Stand facing and leaning with your hands on a firm surface with feet placed slightly apart. Taking as much weight as you need through your hands, rise up on to your toes and down again. Repeat for as many times as you feel reasonable.

As the exercise gets easier reduce the support through your hands.

Eventually you should be able to do the exercise on the injured leg alone. Test your good leg to see the maximum number of repetitions you can do. Work towards the same number on the injured leg.

It is important to continue exercises 3-5 until there is no difference between your two legs, to reduce the chance of a repeat injury.

For the first two weeks following injury avoid excessive discomfort during activity. Exercise such as cycling, swimming and walking are good for the healing muscle.
However do not return to any form of running sports until the calf has regained full stretch and strength.

You may be aware of tightness in the muscle after prolonged inactivity or first thing in the morning. This will gradually settle.

Depending on how severely your calf is injured, it may take up to 8 weeks to return to normal.

In future it is advisable to ‘warm’ up the calf before sporting activities, in order to prevent re-injury. Exercises 3 – 5 can be used for this purpose.

Remember

• 1-3 days, protect, rest, ice elevate.
• 3-14 days, exercises, build up activity avoiding excessive discomfort or strain.
• 14 days onwards, progress exercises, be less protective.
• By 8 weeks you should have returned to all your usual activities.

If you are concerned about your injury, please consult your GP.

© North Bristol NHS Trust.  This edition published April 2024. Review due April 2027. NBT002257. 

An ankle sprain is a common injury and involves injury to the ligaments that support the ankle joint. 

Approximately 2 million incidences of ankle sprain injuries will present to A&E each year. 

Most ankle sprains will heal within a few weeks but it is important to follow a few simple rules to aid this process and help prevent further injury.

The ankle joint is supported by ligaments which help to keep the joint stable. These ankle ligaments could be injured to varying degrees when you sprain your ankle.

These ligaments could be stretched or torn when you twist or roll your ankle.

Following injury, your ankle may be swollen, bruised, painful or stiff. In order to help the natural healing process, follow the advice on this page.

During the first 24-72 hours

Initial treatment is to calm inflammation and control the swelling and pain. This can be managed with:

• Rest. Reduce your activity but try and walk as normally as possible. Avoid forceful or strenuous activities, like running or jumping, until the pain and swelling has settled.
• Ice or frozen peas in a damp tea towel can be applied to the injured area. Apply for up to 20 minutes every 2 hours. Cold can burn so remove if uncomfortable.
• Painkillers are important to help you keep moving around. Paracetamol and ibuprofen are effective pain killers when taken regularly and can be taken together. We do not routinely dispense these as they can be bought cheaply over the counter from a chemist or supermarket. Read the packet instructions for the doses.
• Elevation of the ankle with the knee supported will discourage swelling. 

We no longer offer compression bandages for sprains as they appear not to have an effect on the speed of recovery. But some people find them comforting to wear and you can purchase them from a pharmacy if you want to try one.

Avoid HARM

• Heat can increase inflammation during the first 72 hours
• Alcohol can also increase the blood flow and swelling and also reduce healing.
• Running or impact exercise can make the injury worse or cause re-injury.
• Massage during the first 72 hours can increase bleeding and swelling.

After 48-72 hours

Once the ankle feels less hot and painful, it is essential to start simple flexibility exercises to prevent stiffness. The exercises suggested should be performed slowly and thoroughly, moving into discomfort but short of pain. They can be repeated hourly through the day.

Exercise 1

• Move your foot up and down at the ankle, moving as far as possible in each direction. Repeat 10 times.

Exercise 2

• Place your foot on a flat surface (on a towel) so that you can slide it forwards and backwards.
• Keep your foot flat on the floor and move it as far as you comfortably can.
• Repeat 10 times, 4 times a day.

Exercise 3

• Move your foot in and out at the ankle, so the sole of the foot turns inwards and then outwards. Repeat 10 times.

Exercise 4

• Combine all the above movements by moving the foot and ankle in as large a circle as possible. 
• Compare the movements of your injured ankle with those of your other ankle. They should eventually be the same.
• You can also place a towel or belt looped around your foot, using it to help move your ankle up and down. Repeat 10 times, 4 times a day.

General exercise

As soon as you are able to put some weight through your injured ankle, start to get up and about more, gradually disregarding your crutches if you have them. Short walks are good for the healing ankle. Steadily build up your walking distance.

Please remember to return your crutches to the Emergency Department when you have finished with them.

Progress your exercises to include the following as soon as you can take full weight comfortably on your injured ankle.

Exercise 5

• Time how long you can stand on your injured ankle without overbalancing. Then practice on your injured leg until it as good as your other leg.
• Once you can do the above for 1 minute, practice throwing, catching or bouncing a ball whilst balancing on your injured leg.
• Try balancing on one leg and closing your eyes. You should eventually be equally good on each leg.

Exercise 6 - for strength

• Hold on to a firm support with your feet slightly apart. Then rise up onto your toes and down.
• Repeat until tired, 3 to 4 times daily.
• Progress to performing the exercise on your injured leg alone until it can do the same as your other leg.

Exercise 7 - to regain essential movement

• Lean forward on a firm surface, placing the injured foot flat in front of your other foot. Lean slowly forward, pushing your knee over your foot whilst keeping your heel flat to the floor
• Hold at the point of tightness for 15 seconds.
• Repeat 4 times.

Evidence shows that the sooner this exercise improves, the more likely your ankle is to fully recover.

If you are keen on keeping fit, then swimming and cycling are suitable forms of exercise. If you are aiming to return to sporting activities, you must build up progressively and be able to complete all of the above exercises prior to starting impact exercise and sport. 

Train so that you can complete all of the different elements of your sport/activity with confidence before you participate in the activity fully. If you play a contact sport, you may require a higher level of rehabilitation than the scope of this information leaflet.

It can take 8 – 12 weeks to recovery from and ankle sprain, and even longer with severe sprains or high ankle sprains. It is worth knowing that following a sprain, the ankle can look thickened or swollen for some time.

If you are concerned about the progress of your ankle, then contact your GP or the Emergency Department that you originally attended.

References and Further Information

References | Sprains and strains | CKS | NICE 

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002629.

This page is for adult patients who have have been examined, and the doctor or nurse is happy for you to go home. For your safety, you should have a responsible adult with you, who has read this information, for 24 hours or until you have recovered.

What symptoms to expect

It is normal after a head injury to experience the following:

• Mild headache
• Sensitivity to bright lights
• Feeling sick (without vomiting)
• Mood changes - feeling angry, anxious, irritable, or struggling to rest are common symptoms
• Difficulty concentrating and retaining information.
• Feeling tired or needing to sleep more

Your recovery

These symptoms should resolve over the next two weeks. If they persist or you have concerns please visit your GP.

You can take simple over the counter analgesics (painkillers) such as paracetamol to help.

• Do rest.
• Do keep well hydrated and avoid stress where possible.
• Resting includes avoiding strenuous activity or rough sports.
• Avoid reading small text or screens such as computers, phones or TV as concentrating on these can make your symptoms worse.
• Do not have alcohol or any sedatives (medicines that help sleep) following your head injury for at least 48 hours.
• Do not drive until you are fully recovered. 
• Do not return to work, college or school until your symptoms have improved. 
• Do not participate in contact sports for at least 3 weeks.
   

Red flag symptoms (when to call for help)

Most head injuries resolve without any serious complications. However, if you experience the following symptoms please call 999 and return to A&E immediately.

• Severe or worsening headache (despite painkillers)
• Vomiting (being sick)
• Dizziness or a lack of co-ordination 
• Increasing confusion or memory problems
• Weakness or numbness
• Excessive sleepiness during normal waking hours
• Fits or seizures, convulsions or collapse.
• Change to your eyesight
• Deafness in one or both ears
• Neck stiffness
   

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002438
 

Coping with nosebleeds

This information is designed to help you cope with any nasal bleeding you may suffer and to suggest ways that may help prevent further episodes.

Why have I had a nosebleed?

Often the cause is unknown. However, some causes can include:

• High blood pressure.
• Picking your nose.
• Recent colds resulting in strong nose blowing.
• Recent sinus or nasal surgery.
• Anti-coagulation therapy.

Where does the bleeding come from?

The nose has a rich blood supply. Blood capillaries all converge in the nasal septum (the thin piece of cartilage separating the nostrils). 

The area of the septum which contains all these blood vessels is known as the Little’s area. Most nosebleeds arise from this point and can be stopped by applying pressure.

Occasionally they can arise from further back in the nose - which makes them more difficult to stop by simply pinching the nose.

What are the first aid procedures to stop the bleeding?

1. Remain calm. Most nosebleeds stop with simple first aid measures.
2. If you are alone, summon help if possible.
3. Sit upright with your head slightly forward. Breathe through your mouth.
4. Apply firm pressure with the thumb and forefinger at the level of the nostrils. You will need to do this for approximately 10-15 minutes. Do not feel tempted to let go sooner, as all the good work done by the compression may be undone by 10 seconds curiosity to see if the bleeding has stopped.
5. Ice packs can be applied to the forehead or bridge of the nose (a packet of frozen peas or similar makes a good ice pack). Sucking a small piece of ice can also assist in stopping the bleeding.
6. Try to spit out any blood going down your throat.

It may be helpful to measure the amount of blood loss. We realise that this is difficult, but try to catch any blood in a bowl. 

What at happens if I cannot stop the bleeding myself?

If after 10-15 minutes the bleeding continues attend the nearest accident and emergency department or call an ambulance.

Sometimes very severe nosebleeds may make you feel faint or dizzy, so make sure you are sitting down. (Standing up may lower and already low blood pressure).

What to do after a recent nosebleed?

• Do not drink very hot fluids for or have hot showers for 24 hours. This can cause the blood vessels to dilate, which can lead to rebleeding.
• Avoid blowing your nose for a couple days to allow the healing area inside the nose to settle down.
• If you feel as if you are going to sneeze, cover your mouth and sneeze through your mouth. Do not try to hold back a sneeze, as this may cause a build up of pressure in your nose which can cause bleeding in the healing area.
• Avoid constipation and straining when going to the toilet, as again this increases the pressure inside your nose. Lots of fibre in your diet may help.
• Do not pick your nose or try to clean it with buds. Doing so will dislodge any healing crusts. It is normal to have bloodstained mucus discharge from your nose for approximately a week.
• Stay away from very smoky places for a week.
• Your nose may feel blocked for up to 10 days following a nosebleed. It will gradually clear.
• Mouth washes may help if your mouth feels dry due to constant breathing through the mouth.
• Drink plenty of cool fluids.
• If your nose is very sore the doctor may prescribe Naseptin cream which will help soothe the nasal mucosa and prevents crusting.
• If you smoke, try to give up or at least cut down. Smoking can irritate the sensitive nasal mucosa, leading to bleeding.

What to do after a severe nosebleed?

Severe nosebleeds can arise higher and further back in the nose. These nosebleeds sometimes do not respond to pressure alone and may require insertion of nasal packing to stop the bleeding. The packs place pressure on the bleeding vessels and so stop the bleeding.

Occasionally the doctor may cauterise the bleeding vessels, which means silver nitrate sticks are inserted into the nostril for a few seconds to seal the bleeding vessel.

What happens if I am admitted to hospital?

If you have had a nasal pack inserted you will need to stay in hospital. This is usually for 24-48 hours to ensure the bleeding will not recur (packs usually remain for up to 24 hours).

In Bristol the ENT department is based at the Bristol Royal Infirmary - and you will be transferred here if you need to stay in.

What to do about anti-coagulant medication?

If you are on anticoagulant or aspirin the doctor should have advised you what to do regarding taking this medication after your nosebleed. If you have not been told what to do with your anticoagulation medication please do ask the emergency department team or your GP.

© North Bristol NHS Trust.  This edition published April 2024. Review due April 2027. NBT002300.

Children’s Activities and Talk in Their Everyday Routines (CHATTER)

Background

Children who are delayed starting to talk compared with other children of the same age are sometimes called ‘late talkers’. Many late talkers go on to ‘catch up’ with their peers, but some children continue to have difficulties understanding and using language into school age and beyond. This is called a developmental language disorder (DLD) and research shows it affects 2 children in every primary school classroom. To help children who are at risk of DLD, speech and language therapists often work with parents of children who are late talkers using parent-child interaction (PCI) approaches. This includes giving parents advice about how to adapt their interactions in ways that support children’s language development in day-to-day life.

However, there are concerns that this type of approach might not be a good fit for all families. PCI approaches are mostly based on studies of mothers and children talking in clinical settings, not at home during everyday routines. Also, many research studies have only included limited, non-diverse groups of families. Because of this, some families have said therapy strategies are hard to fit into their daily routines or are culturally inappropriate.  

Aims of the study

The CHATTER study is being run by Caitlin Holme as part of her PhD at the University of Bristol, and is funded by the Heather van der Lely foundation.

Through this study we want to find out more about how parents and children with typically developing language talk to each other on a typical day. We want to understand how talk varies at different times of day and during different activities, and what parents think about their child’s everyday interactions and activities. If we understand more about diverse interactions between parents and typically developing children, we will know more about what advice to give to parents whose child is struggling with language. We will also be able to think about how advice can be useful, culturally appropriate and fit better with families’ everyday lives.

The research aims are:

1. To understand variation in daily opportunities for interaction in typically developing children from a diverse range of backgrounds, through exploration of activities in their everyday lives and how these relate to interactions on a typical day.

2. To combine observations made in (1) with family perspectives on and explanations of the interactions identified in relation to their context and daily routines.

3.To explore how the findings and methodology used in (1) and (2) could be used to impact clinical practice and improve ecological validity of parent-child interaction therapy.

What will happen in the study?

We hope to recruit a small number of families with a child aged 2.5 to 4 years.

The study will have 3 main steps of data collection:

1. Families will be given a ‘LENA’ device to record their child’s interactions over a ‘typical day’ of their choice. This is a small audio recorder which fits in a pocket worn over the child’s clothes. The recorder then gives an automatic analysis of times when the child uses and hears language during the day.
2. We will ask families to take photographs of the different activities they and their child were doing on the day.
3. Then we will meet for an informal chat about their daily routine and their child’s language and do some activities together like making a timeline of their day.

Information from the LENA recordings, photographs, timelines and conversations will then be explored in depth to build a rich description of different family contexts and communication environments.

How can I find out more?

If you are interested in finding out more about the study, please contact Caitlin at caitlin.holme@bristol.ac.uk or 0117 4143951.

To find out more you can watch this video of Caitlin explaining the project:

https://www.youtube.com/watch?v=DzOKphACBOw