Title: Riot Control Agents - submitted by Jake Danoff<br/>Author: Hong Kim<br/><a href='http://umem.org/profiles/faculty/526/'>[Click to email author]</a><hr/><p>
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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: </p>
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Mace (2-chloroacetophenone)</li>
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Pepper spray (capsaicins)</li>
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Tear gas (O-chlorobenzylidene malonitrile)</li>
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These agents (irritants) primarily affect the eye, skin, and respiratory tract.</p>
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<strong>Organ</strong></p>
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<strong>Effect</strong></p>
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<strong>Management</strong></p>
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<em>Eyes</em></p>
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· Lacrimination</p>
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· Blepharospasm</p>
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· Conjunctiva irritation/conjunctivitis </p>
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· Periorbital edema</p>
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· Corneal abrasions </p>
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· Copious H<sub>2</sub>0/saline irrigation with <a href="https://www.youtube.com/watch?v=ig_W9tkH5Bw">Morgan Lens</a>or <a href="https://www.procedurettes.com/eye-irrigation">Nasal Cannula jury-rig</a></p>
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· Slit lamp exam for corneal abrasions </p>
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<em>Skin</em></p>
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· Burning sensation</p>
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· Blister</p>
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· Contact dermatitis</p>
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· 2<sup>nd</sup> degree burns (mace) </p>
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· Wash with soap and water</p>
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· Wound care </p>
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<em>Airway/respiratory tract</em></p>
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· Respiratory tract irritation</p>
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· Rhinorrhea</p>
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· Laryngospasm</p>
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· Bronchospasm</p>
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· Chemical pneumonitis</p>
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· B<sub>2</sub>-agonists for bronchospasm</p>
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· Steroids if worsening underlying reactive airway disease </p>
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· CXR to evaluate for possible pneumonitis </p>
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· Supplementary oxygen as needed</p>
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Mangement:</p>
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Initial management involves copious irritation of the affected area with water. </li>
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There is limited evidence that decontamination with milk, milk of magnesia, or baby shampoo is better than water. </li>
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Always consider projectile or blunt trauma that may be associated with the riot-control-related ED visits/complaint. </li>
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Protect yourself by wearing PPE when evaluating/treating these patients.</li>
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<fieldset><legend>References</legend>
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Fisher, W. (2020). Procedurettes.com. Retrieved 3 June 2020, from <a href="https://www.procedurettes.com/eye-irrigation">https://www.procedurettes.com/eye-irrigation</a>.</li>
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Schep, L., Slaughter, R., & McBride, D. (2013). Riot control agents: the tear gases CN, CS and OC—a medical review. <em>Journal Of The Royal Army Medical Corps</em>, <em>161</em>(2), 94-99. <a href="https://doi.org/10.1136/jramc-2013-000165">https://doi.org/10.1136/jramc-2013-000165</a></li>
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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. <em>Western Journal Of Emergency Medicine</em>, <em>19</em>(2), 294-300. <a href="https://doi.org/10.5811/westjem.2017.12.36307">https://doi.org/10.5811/westjem.2017.12.36307</a></li>
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<em>The Morgan Lens for emergency eye irrigation</em>. Youtube. (2020). Retrieved 3 June 2020, from <a href="https://www.youtube.com/watch?v=ig_W9tkH5Bw">https://www.youtube.com/watch?v=ig_W9tkH5Bw</a>.</li>
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