Over the past several days, riot control agents have been used against the protest participants (related to Mr. George Floyd’s death). There are 3 widely used riot control “lacrimating” agents: 

1. Mace (2-chloroacetophenone)
2. Pepper spray (capsaicins)
3. Tear gas (O-chlorobenzylidene malonitrile)

These agents (irritants) primarily affect the eye, skin, and respiratory tract.

 

 

Organ	Effect	Management
Eyes	·    Lacrimination ·    Blepharospasm ·    Conjunctiva irritation/conjunctivitis  ·    Periorbital edema ·    Corneal abrasions	·     Copious H20/saline irrigation with Morgan Lensor Nasal Cannula jury-rig ·     Slit lamp exam for corneal abrasions
Skin	·    Burning sensation ·    Blister ·    Contact dermatitis ·    2nd degree burns (mace)	·     Wash with soap and water ·     Wound care
Airway/respiratory tract	·    Respiratory tract irritation ·    Rhinorrhea ·    Laryngospasm ·    Bronchospasm ·    Chemical pneumonitis	·     B2-agonists for bronchospasm ·     Steroids if worsening underlying reactive airway disease  ·     CXR to evaluate for possible pneumonitis  ·     Supplementary oxygen as needed

 

Mangement:

• Initial management involves copious irritation of the affected area with water. 
• There is limited evidence that decontamination with milk, milk of magnesia, or baby shampoo is better than water. 
• Always consider projectile or blunt trauma that may be associated with the riot-control-related ED visits/complaint. 
• Protect yourself by wearing PPE when evaluating/treating these patients.

References

1. Fisher, W. (2020). Procedurettes.com. Retrieved 3 June 2020, from https://www.procedurettes.com/eye-irrigation.
2. Schep, L., Slaughter, R., & McBride, D. (2013). Riot control agents: the tear gases CN, CS and OC—a medical review. Journal Of The Royal Army Medical Corps, 161(2), 94-99. https://doi.org/10.1136/jramc-2013-000165
3. Stopyra, J., Winslow III, J., Johnson III, J., Hill, K., & Bozeman, W. (2018). Baby Shampoo to Relieve the Discomfort of Tear Gas and Pepper Spray Exposure: A Randomized Controlled Trial. Western Journal Of Emergency Medicine, 19(2), 294-300. https://doi.org/10.5811/westjem.2017.12.36307
4. The Morgan Lens for emergency eye irrigation. Youtube. (2020). Retrieved 3 June 2020, from https://www.youtube.com/watch?v=ig_W9tkH5Bw.