Medical Aspects of Chemical Warfare (2008) - The Black Vault

Riot Control AgentsNC); or Cool It! wipes and spray (Defense Technology,Casper, Wyo); claim to help decontaminate andreduce pain in people exposed to pepper sprays andother RCAs. 191–193TreatmentSkinSkin erythema that appears early (up to 1 hourafter exposure) is transient and usually does notrequire treatment. Delayed-onset erythema (irritantdermatitis) can be treated with a bland lotion suchas calamine lotion or topical corticosteroid preparations(eg, 0.10% triamcinolone acetonide, 0.025%fluocinolone acetonide, 0.05% flurandrenolone, orbetamethasone-17-valerate). Cosmetics, includingfoundation and false eyelashes, can trap agent andshould be removed to insure complete decontamination.22 When the patient has been exposed to OC, theuse of creams or ointments should be delayed for 6hours after exposure. 194 Patients with blisters shouldbe managed as having a second-degree burn. 195 Acutecontact dermatitis that is oozing should be treatedwith wet dressings (moistened with fluids such as 1:40Burow solution or colloidal solution) for 30 minutes,three times daily. 3,187 Topical steroids should be appliedimmediately following the wet dressing. Appropriateantibiotics should be given for secondary infection, andoral antihistamines for itching. 3,187 Vesicating lesionshave been successfully treated with compresses of acold silver nitrate solution (1:1,000) for 1 hour, appliedsix times daily. 75 One person with severe lesions andmarked discomfort was given a short course of an oralsteroid. An antibiotic ointment was applied locally,but systemic antibiotics were not used. 75 With severeblistering resulting in second-degree burns, skin pigmentationchanges can occur. 4EyeThe effects of RCAs on the eyes are self-limiting anddo not normally require treatment; however, if largeparticles of solid agent are in the eye, the patient shouldbe treated as if for exposure to corrosive materials. 195The individual should be kept from rubbing the eyes,which can rub particles or agent into the eye and causedamage. 24 Contact lenses should be removed. 194Yih recommends that before irrigating eyes contaminatedwith CS, they should be blown dry, directly,with an electric fan, which helps dissolved particlesevaporate and rapidly reduces pain (irrigating theeyes before drying causes additional, unnecessary,pain. 82 However, other researchers note that if Yih’srecommendations are used, the care provider mustbe certain that the agent is CS, for such a delay indecontaminating more toxic agents such as ammoniawould result in severe eye injury. With all agents, theaffected eyes should be thoroughly flushed with copiousamounts of normal saline or water for severalminutes (some sources suggest 10 minutes) to removethe agent. 194Eye injury assessment should include a slit lampexamination with fluorescein staining to evaluate forcorneal abrasions that could be caused by rubbingparticles of the agent into the eye. 4,196 Patients shouldbe closely observed for development of corneal opacityand iritis, particularly those who have been exposedto CN or CA. A local anesthetic can be used for severepain, but continued anesthetic use should be restricted.If the lesion is severe, the patient should be sent fordefinitive ophthalmologic treatment.Viala et al 197 reported a study of five French gendarmeswho had CS exposure and were decontaminatedwith Diphoterine (Prevor, Valmondois, France),which dramatically resolved the effects in four ofthem. The researchers also recommended using it asa prophylaxis to reduce or prevent lacrimation, eyeirritation, and blepharospasm. 197Respiratory TractTypically, RCA-induced cough, chest discomfort,and mild dyspnea are resolved within 30 minutes afterexposure to clean air. However, both the animal data(detailed in the section on CS) and clinical experiencewith an infant exposed to CS 198 suggest that severerespiratory effects may not become manifest until 12to 24 hours after exposure. If persistent bronchospasmlasting several hours develops, systemic or inhaledbronchodilators (eg, albuterol 0.5%) can be effectivein reducing the condition. 4,196Individuals with prolonged dyspnea or objectivesigns such as coughing, sneezing, breath holding, andexcessive salivation should be hospitalized under carefulobservation. Treatment in these cases may includethe introduction of systemic aminophylline and systemicglucocorticosteroids. 4,55 A chest radiograph canassist in diagnosis and treatment for patients with significantrespiratory complaints. 196 If respiratory failureoccurs, the use of extracorporeal membrane oxygenationcan be effective without causing long-term damageto the lungs. 4,199 High-pressure ventilation, whichcan cause lung scarring, should not be used. Althoughpeople with chronic bronchitis have been exposed toRCAs without effects, any underlying lung disease(eg, asthma, which affects one person in six) might beexacerbated by exposure to CS. 3,200 In most cases the471