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

Updated: May 24, 2018
  • Author: Paul P Rega, MD, FACEP; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Treatment

Approach Considerations

No antidote exists. Treatment is symptomatic and supportive. Treatment for ocular exposures initially requires thorough eye decontamination. Flushing the eyes with water or saline for 10–20 min is the most often recommended initial treatment for decontamination of the eyes. Potential decontamination agents have been studied, including Maalox, 2% lidocaine gel, milk, and baby shampoo, but none showed efficacy compared to water. [2, 20]

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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). Decontaminate 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 anaesthetic 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

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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.

 

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Consultations

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

  • Ophthalmology
  • Burn specialists
  • Mental health
  • Pulmonology
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Long-Term Monitoring

Opthalmology possibly with significant damage to the eyes;

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