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

Updated: Aug 01, 2018
  • Author: Paul P Rega, MD, FACEP; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
  • Print
Treatment

Approach Considerations

No antidote to riot control agents (RCAs) exists, so treatment is symptomatic and supportive. Treatment measures for RCA exposure include the following:

  • Remove the patient from the source. Since aerosolized tear gas is heavier than air, HAZMAT rescuers should get the incapacitated victim off the ground as expeditiously as possible. [1]
  • Remove clothes if clothing has been contaminated by RCAs.
  • Ocular exposures initially require thorough eye decontamination. Flushing the eyes with water or saline for 10–20 min is the most often recommended for initial decontamination.
  • Dermal exposures require simple soap and water decontamination for the most part. [1]  Potential decontamination agents have been studied, including aluminium hydroxide/magnesium hydroxide antacid, 2% lidocaine gel, milk, and baby shampoo, but none showed better efficacy than water. [1, 21]
Next:

Prehospital Care

Most people exposed to irritants do not seek medical care, and effects are self-limited. When persons seek care, first withdraw them from exposure. Responders should wear appropriate personal protective equipment (PPE). Decontamination should then proceed as follows:

  • Remove contaminated external clothing

  • 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

  • Thoroughly flush eyes with water or saline; Patents may require a topical anesthetic to enable them to open their eyelids sufficiently for effective irrigation. Contact lenses should be removed before flushing.

  • Devote specific attention to very young, infirm, and elderly patients, since their responses to these agents may be significant
  • Bronchodilator therapy may be utilized for those with post-exposure bronchospasm

  • Warn patients that the pain worsens during decontamination

  • In patients with severe respiratory compromise, aggressive airway control, including invasive measures, may be required

Previous
Next:

Emergency Department Care

Initiate or continue care in the emergency department (ED) as follows:

  • ED personnel should don proper personal protection equipment (PPE) to minimize accidental exposure

  • A site should be established for the disrobing and general decontamination (see Prehospital Care) 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

  • Treat bronchospasm with bronchodilators

  • Topical/parenteral analgesia as needed

Most patients with irritant exposure can safely be discharged from the ED, as the few reported dangerous effects occur rapidly.The rare patient with significant respiratory damage may require oxygen supplementation, aggressive bronchodilator therapy (if bronchospasm is present), and admission to the hospital, possibly a critical care unit.

Characteristically, hospital admission for extended medical care is not indicated.  Should hospitalization be required, consider alternative diagnoses.

 

Previous
Next:

Medical Care

Victims should be made aware that initial symptoms may be minimal or that there may even be a latent period.  Should any clinical deterioration occur the patient should be re-evaluated.

Medical follow-up is indicated for a minority of patients, including those with any of the following:

  • Very young age
  • Advanced age
  • Co-morbidities
  • Significant dermal injuries
  • Prolonged respiratory difficulties
Previous
Next:

Consultations

Consultations with one or more of the following may be indicated:

  • Ophthalmology
  • Burn specialists
  • Mental health
  • Pulmonology
Previous
Next:

Diet

No restrictions;

Previous
Next:

Activity

As tolerated;

Previous
Next:

Prevention

Not applicable;

Previous
Next:

Long-Term Monitoring

Opthalmology possibly with significant damage to the eyes;

Pulmonology should there be any long-term respiratory complications; 

Mental health;

Burn care;

Previous