Saturday, 18 August 2018

Most cuts and grazes are minor

can be easily treated at home.

Stopping the bleeding, cleaning the wound thoroughly and covering it with a plaster or dressing is usually all that's needed.

Minor wounds should start to heal within a few days.

How to treat cuts and grazes
Stop the bleeding
Stop any bleeding before applying a dressing to the wound. Apply pressure to the area using a clean and dry absorbent material – such as a bandage, towel or handkerchief – for several minutes.

If the cut is to your hand or arm, raise it above your head to help reduce the flow of blood.

If the injury is to a lower limb, lie down and raise the affected area above the level of your heart.

Clean the wound and apply a dressing
When the wound has stopped bleeding, clean it and cover it with a dressing to help stop it becoming infected.

To do this:

wash and dry your hands thoroughly
clean the wound under drinking-quality running tap water – avoid using antiseptic as it may damage the skin and slow healing
pat the area dry with a clean towel
apply a sterile adhesive dressing, such as a plaster – read more about how to apply plasters and other dressings
Keep the dressing clean by changing it as often as necessary. Keep the wound dry by using waterproof dressings, which will allow you to take showers.

You can remove the dressing after a few days, once the wound has closed itself.

Take painkillers if needed
If the wound is painful for the first few days, you can take over-the-counter painkillers such as paracetamol or ibuprofen.

When to get medical help
Call NHS 111 or visit your local walk-in centre, minor injuries unit or GP surgery if there's a risk your wound could become infected, or you think it's already infected.

A wound is at risk of infection if:

it has been contaminated with dirt, pus or other bodily fluids
there was something in the wound before it was cleaned, such as gravel or a shard of glass
it has a jagged edge
it's longer than 5cm (2 inches)
it was caused by an animal or human bite
Signs a wound has become infected include:

swelling, redness and increasing pain in the affected area
pus forming in or around the wound
feeling generally unwell
a high temperature (fever) of 38C (100.4F) or above
swollen glands under the chin or in the neck, armpits or groin
An infected wound can usually be successfully treated with a short course of antibiotics.

When to go to A&E
Go to your nearest accident and emergency (A&E) department as soon as possible if:

you cannot stop the bleedingCyclical vomiting syndrome (CVS) is a rare disorder that mainly affects children. It causes repeated episodes of vomiting and feeling sick.

CVS has no apparent cause – the vomiting episodes aren't the result of an infection or illness.

It can be frightening, but it's possible to manage CVS with lifestyle changes and medication. It usually clears up before adulthood.

Symptoms of CVS
Someone with CVS will feel very sick and may vomit for hours or even days at a time. They'll recover from the episode and feel perfectly well before having another episode perhaps a month or so later.

CVS can last for months, years or even decades. The symptoms can be so severe that some people need to be admitted to hospital for treatment.

An episode of CVS has four distinct phases:

1. Prodrome phase
During the prodrome phase, the person will:

feel an episode of vomiting is about to start
have intense sweating and nausea for a few minutes to a few hours
appear unusually pale
2. Vomiting phase
The vomiting phase involves nausea, vomiting and retching. The person may:

have periods of retching and vomiting, which can last for 20 to 30 minutes
vomit up to 5 or 6 times an hour, for up to 10 days
be unresponsive and unable to move
have other symptoms, including abdominal pain, diarrhoea, fever, dizziness, headache, sensitivity to light, very pale skin, drowsiness, drooling or spitting excess saliva
3. Recovery phase
During the recovery phase:

vomiting and retching stop, and nausea subsides
other symptoms improve
Recovery can be immediate or gradual.

4. Well phase
The well phase is a period where there are no symptoms.

The cycle is usually regular and predictable, with the same symptoms starting at the same time of the day and lasting for the same duration.

What causes CVS?
The cause of CVS is currently unknown, but there may be a link with migraine. Many people with CVS develop migraines, and migraine medicines have been shown to help treat the syndrome.

Vomiting episodes can sometimes be triggered by:

emotional stress – excitement, anxiety or panic attacks
an infection – such as a sinus infection, respiratory infection or the flu
certain foods – such as chocolate, cheese, cured meats, and food containing MSG (monosodium glutamate)
caffeine
hot weather
periods
motion sickness
unhealthy eating habits – overeating, not eating for long periods or eating just before bedtime
physical exhaustion or too much exercise
sleep deprivation
Who's affected
CVS tends to occur in childhood, with around half of those affected having symptoms before the age of three.

CVS often clears up by adulthood but can sometimes continue into it.

Children who get migraines and are sensitive to light and sound are more likely to develop CVS. Having a family history of migraines also increases your risk.

Diagnosing CVS
For children, your GP will ask about your child's symptoms and medical history. CVS may be suspected if all of the following criteria are present:

at least two or more intense and continuous episodes of nausea and vomiting lasting from hours to days within a six-month period
episodes are similar each time
episodes are separated by weeks to months, with a return to normal health between episodes
following medical assessment, the symptoms can't be attributed to another disorder that causes the vomiting
In adults, CVS may be diagnosed if you've had three or more similar vomiting episodes in the past 12 months, with no nausea or vomiting between episodes, and another condition isn't the cause.

The high frequency of vomiting and the fact episodes tend to start at the same time of day indicate CVS, rather than another condition, may be the cause.

Blood or urine tests may be used to rule out an infection or kidney problems. Scans, such as an endoscopy or abdominal ultrasound, may be carried out to see whether there's an abnormality in the digestive tract.

Long-term use of cannabis can cause symptoms very similar to CVS (known as "cannabinoid-induced hyperemesis").

CVS will only be diagnosed after other conditions or potential causes have been ruled out. By this stage, you may have been referred to a gastroenterologist, a specialist in digestive system disorders.

Managing a vomiting episode
When a vomiting episode starts, it's a good idea to stay in bed in a quiet, dark room and take any medicines prescribed for this stage of the cycle.

Keep taking small sips of fluid to prevent dehydration. Water, diluted squash, diluted fruit juice or semi-skimmed milk are best.

After the vomiting episode has finished:

drink plenty of fluids and gradually resume your normal diet
take any medicines prescribed to prevent future episodes
A child or adult who's been diagnosed with CVS will usually be under the care of a specialist, such as a gastroenterologist.

Medication
A number of medicines can be prescribed to help treat and prevent CVS. For example, you or your child may be prescribed:

medicine to prevent nausea and vomiting – such as ondansetron
medicine for abdominal pain – such as ibuprofen or amitriptyline (for those older than five years)
medicine to control stomach acid production – such as ranitidine, lansoprazole or omeprazole
migraine treatments – such as sumatriptan and propranolol; read more about the medicines used to treat migraines and medicines used to prevent migraines
It may take a while to find a medicine, or combination of medicines, that works for you.

Hospital treatment
Hospital treatment may be needed if nausea and vomiting is severe. Medicine and fluids may need to be given intravenously (directly into a vein) to relieve symptoms and prevent dehydration. Nutrition may also need to be given intravenously if vomiting continues for days.

Preventing vomiting
It may be possible to prevent or reduce vomiting episodes by:

avoiding known triggers, such as certain foods
getting enough sleep
treating any sinus problems or allergies
taking steps to manage stress or anxiety
eating small carbohydrate-based snacks between meals, before exercise and at bedtime – this can help prevent future attacks in some people

you're bleeding from an artery – blood from an artery comes out in spurts with each beat of the heart, and is bright red and usually hard to control
you experience persisting or significant loss of sensation near the wound or you're having trouble moving any body parts
you have received a severe cut to the face – you may require urgent treatment to prevent scarring
you have received a cut to the palm of your hand and it looks infected – these types of infection can spread quickly
there's a possibility a foreign body is still inside the wound
the wound is very large or the injury has caused a lot of tissue damage
In A&E, your wound will be examined to determine whether there's any risk of infection. You may need a booster injection to prevent tetanus, and your wound may be closed with stitches, strips or special glue before a dressing is applied.

If your wound is at risk of infection, it won't usually be closed because this may trap any infection inside. Instead, it will be packed with a non-sticky dressing before being covered with a protective dressing until it's safe to close.

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