Management of the effects of exposure to tear gas

Carron, Pierre‐Nicolas; Yersin, Bertrand

doi:10.1136/bmj.b2283

Cited by 27 publications

(23 citation statements)

References 29 publications

(21 reference statements)

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“…Aerosolised tear gases are heavier than air, and any exposed patient who has lost consciousness or is lying should be lifted off the ground; emergency response vehicles should also try and park in higher areas 2. Transport to a medical facility is recommended for symptomatic exposures.…”

Section: Managementmentioning

confidence: 99%

“…For example, among attending physicians treating exposed patients, minor effects such as facial pruritis and respiratory and eye irritation may develop 34 37 40 84. Removal of contaminated clothing, prompt decontamination, the use of gloves, goggles, gowns and surgical masks by medical personnel, and, if possible, treatment in a well-ventilated room are recommended to minimise secondary contamination 2 33 40 61 83 84. Removed contaminated clothing should be sealed in a double plastic bag 12…”

Section: Managementmentioning

confidence: 99%

“…Flushing the eyes with water or saline for 10–20 min is the most often recommended initial treatment for decontamination of the eyes 1 2 27 33 34 61 85. Some have recommended using air flow over the eyes, such as that directed from fans or the use of a cold hairdryer to decontaminate the eyes following exposure to aerosolised smoke products 18 48 68 86 87.…”

Section: Managementmentioning

confidence: 99%

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Riot control agents: the tear gases CN, CS and OC—a medical review

2013

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Introduction2-Chloroacetophenone (CN),o-chlorobenzylidene malonitrile (CS) and oleoresin capsicum (OC) are common riot control agents. While serious systemic effects are uncommon, exposure to high concentrations may lead to severe complications and even death. The aim of this narrative review is to summarise all main aspects of the riot control agents CN, CS and OC toxicology, including mechanisms of toxicity, clinical features and management.MethodsOVID MEDLINE and ISI Web of Science were searched for terms associated with CN, CS and OC toxicity in humans and those describing the mechanism of action, clinical features and treatment protocols.ResultsCN, CS and OC are effective lacrimating agents; evidence for toxicity, as measured by the threshold for irritation, is greatest for CN, followed by CS and OC. Typically, ocular and respiratory tract irritation occurs within 20–60 s of exposure. Ocular effects involve blepharospasm, photophobia, conjunctivitis and periorbital oedema. Following inhalation, effects may include a stinging or burning sensation in the nose, tight chest, sore throat, coughing, dyspnoea and difficulty breathing. Dermal outcomes are variable, more severe for CN and include dermal irritation, bulla formation and subcutaneous oedema. Removal from the contaminated area and fresh air is a priority. There is no antidote; treatment consists of thorough decontamination and symptom-directed supportive care. Ocular exposure requires thorough eye decontamination, an eye exam and appropriate pain management. Monitoring and support of respiratory function is important in patients with significant respiratory symptoms. Standard treatment protocols may be required with patients with pre-existing respiratory conditions. Dermal exposures may require systemic steroids for patients who develop delayed contact dermatitis.ConclusionsCN, CS and OC are effective riot control agents. In the majority of exposures, significant clinical effects are not anticipated. The irritant effects can be minimised both by rapid evacuation from sites of exposure, decontamination and appropriate supportive care.

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Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

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Riot control agents: the tear gases CN, CS and OC—a medical review

2013

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“…Despite their use as chemical warfare agents more than a century, there is no specific antidote for sulfur mustard or tear gas agent-induced cutaneous injuries (9). Although some therapeutic agents were tested for SM and CS tear agent-induced injuries, symptomatic treatment is the general line of treatment (8, 9, 18, 20-23). Decontamination of affected subjects is crucial in mitigating the injuries.…”

Section: Introductionmentioning

confidence: 99%

Accelerating Inflammation Resolution to Counteract Chemical Cutaneous Injury

Achanta¹,

Chintagari

Balakrishna

et al. 2019

Preprint

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Running title: Lipid mediators mitigate chemical skin injury Abbreviations:RvD1 (Resolvin D1); RvD2 (Resolvin D2); CS (2-Chlorobenzalmalononitrile); CEES (2-chloroethylethyl-sulfide); SM (sulfur mustard); HD (sulfur mustard); MMP-9 (matrix metallo protein-9), IL-1β (Interleukin-1 beta), KC/CXCL1 (keratinocyte chemoattractant)/(chemokine (C-X-C motif) ligand 1); CXCL2 (chemokine (C-X-C motif) ligand 2); IL-6 (interleukin-6); ELISA (enzyme linked immune sorbent assay); PBS (phosphate buffer saline); MEVM (mouse ear vesicant model); i.p (intraperitoneal); i.v (intravenous); NSAIDs (nonsteroidal anti-inflammatory drugs) AbstractChemical exposure to vesicants such as sulfur mustard (SM), and electrophilic riot control agents such as 2-chlorobenzalmalononitrile (CS) tear gas agent, cause strong cutaneous inflammation. Classical antiinflammatory treatments have focused on interference with target initiation and maintenance of inflammation, with mixed outcomes. Inflammation is broadly classified into three temporal phases, initiation, amplification and maintenance, and resolution. Resolution of inflammation was thought to be a passive process but the recent body of literature shows that resolution is an active process and is mediated by fatty acid-derived mediators (specialized pro-resolving mediators, SPMs). We hypothesized that accelerating resolution phase of inflammation may attenuate the exaggerated inflammatory response following chemical threat exposure, leading to decreased morbidity and improved recovery. In this study, SPMs, such as Resolvin D1 (RvD1) and Resolvin D2 (RvD2), were administered to mice at nanogram doses post-exposure to an SM analog, 2-chloroethyl-ethyl-sulfide (CEES) or CS tear gas agent.SPMs decreased edema (ear thickness and punch biopsy weights), pro-inflammatory cytokines (IL-1β, CXCL1/KC, MIP2) and protease marker (MMP-9), and vascular leakage (determined by IRDye 800 CW PEG) while improving histopathology in cutaneous chemical injury mouse models. These results support our hypothesis and pave the way for SPMs for further development as potential medical countermeasures for chemical threat agents-induced skin injuries.A new area of inflammation research has focused on the process of inflammation resolution (29-32). Resolution of inflammation was thought to occur due to the lack of inflammatory drive when concentrations of inflammation-initiating and -maintaining mediators are removed or in decline.However, new studies show that the resolution of inflammation is an active mechanism involving the activation of signaling pathways during inflammation initiation, and the later generation of fatty-acidderived specialized pro-resolving mediators (SPMs) that activate resolution mechanisms. These mediators include resolvins, lipoxins, protectins, and maresins. Resolvins and protectins are omega-3 fatty acids derived from docosahexaenoic acid (DHA; C22:6) or eicosapentaenoic acid (EPA; C20:5),We appreciate thoughtful discussions of Drs. Conflict of interestAuthors do not have any conflicts of interes...

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“…Gas forms of chemical irritants are contained in canisters or grenades and typically are triggered to conduct a thermal explosion and disperse widely in the surrounding area. 39 The Median Incapacitating Dose (ID50) is the amount of agent expected to incapacitate 50 percent of a group of exposed, unprotected individuals. The Median Lethal Dose (LD50) is the amount of agent expected to kill 50 percent of a group of exposed, unprotected individuals.…”

Section: Mechanism Of Actionmentioning

confidence: 99%

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Preventing War and Promoting Peace

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Management of the effects of exposure to tear gas

Cited by 27 publications

References 29 publications

Riot control agents: the tear gases CN, CS and OC—a medical review

Riot control agents: the tear gases CN, CS and OC—a medical review

Accelerating Inflammation Resolution to Counteract Chemical Cutaneous Injury

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