Irritants - CS, CN, CNC, CA, CR, CNB, PS Treatment & Management

  • Author: Paul P Rega, MD, FACEP; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Aug 29, 2011
 

Prehospital Care

No antidote exists to reverse the effects of exposure.

Most people exposed to pulmonary irritants do not seek medical care, and effects are self-limited.

  • When patients seek care, first withdraw them from exposure. Then, decontaminate patients.
    • Acceptable decontaminating solutions are water or soap and water.
    • Do not use hypochlorite. This relatively caustic solution may worsen the condition of skin injuries already suffered from exposure to irritants.
    • Devote specific attention to very young, infirm, and elderly patients since their responses to these agents may be significant.
    • Warn patients that the pain worsens during decontamination.
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Emergency Department Care

No antidote exists. Treatment is symptomatic and supportive.

Initiate or continue care in the emergency department as discussed above.

  • Proper personal protection equipment (PPE) should be donned in order to minimize accidental exposure.
  • A site should be established for the disrobing and general decontamination of the patients.
  • Flush the eyes of patients with eye complaints with normal saline or water to remove any particulate matter before fluorescein slit lamp examination for corneal abrasion.
  • Treat more severe injuries, which occur in fewer than 1% of patients, in the usual fashion.
  • Corneal abrasions can be treated with local antibiotics, oral analgesics, and close follow-up care.
  • The rare eye foreign body may merit ophthalmologic consultation.
  • Treat burns based on the severity and location of injury.
  • The patient with significant respiratory damage is rare and may require oxygen supplementation, bronchodilator therapy (if bronchospasm is present), and admission to the hospital, possibly a critical care unit.
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Contributor Information and Disclosures
Author

Paul P Rega, MD, FACEP  Assistant Professor, Department of Public Health and Preventive Medicine, The University of Toledo College of Medicine; Assistant Professor, Department of Emergency Medicine, The University of Toledo College of Medicine; Director of Emergency Medicine Education and Disaster Management, OMNI Health Services

Paul P Rega, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark Keim, MD  Senior Science Advisor, Office of the Director, National Center for Environmental Health, Centers for Disease Control and Prevention

Mark Keim, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Eric Mowatt-Larssen, MD, and David P Sole, DO, to the development and writing of this article.

References

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