Pepper spray
Contents
Background
Pepper (oleoresin capsicum) spray is a commonly used riot-control and violence suppressive agent. It was first used by Federal Bureau of Investigation personnel in the US in 1973.[1] The majority of the uses do not cause life threatening clinical effects. Commonly encountered effects include conjunctivitis, blepharospasm, and self induced corneal abrasions. Early decontamination minimizes the irritant effects.[2]
Active Ingredients
Oleoresin capsicum (OC) is the main active ingredient and is extracted from the genus of the plant Capsicum annuum. The five capsaicinoids include:
- Capsaicin
- Dihydrocapsaicin
- Nordihydrocapsaicin
- homocapsaicin
- Homodihydrocapsaicin
Capsaicin and dihydrocapsaicin constitute 80-90% of pepper spray[3]
Death Associated with Pepper Spray
- A Patient with excited delirium, placed in physical restraint (handcuffed in prone position) with a history of chronic bronchitis experienced asphyxia due to bronchospasm[4]
Clinical Features
- Painful burning sensation on skin
- Involuntary eye closure
- Decreased hand eye coordination
- Lacrimation
- Blepharospasm
- Conjunctival injection
- Cough
- Shortness of Breath
- Throat pain
Differential Diagnosis
Medical Conditions
Chemical weapons
- Blister chemical agents (Vesicants)
- Lewisite (L)
- Sulfur mustard (H)
- Phosgene oxime (CX)
- Pulmonary chemical agents
- Incendiary agents
- Cyanide chemical weapon agents
- Nerve Agents
- Acetylcholinesterase inhibitors
- Includes household and commercial pesticides (diazinon and parathion)
- G-series (sarin, tabun, soman) and V-series (VX)
- V-series high viscosity with oily consistency
Evaluation
Evaluation is focused on the irritated bodily area which is usually the eyes, throat, and skin, and lungs.[5]
Ophthalmologic
- Assess for corneal abrasions (approx 7% incidence) and blepharitis
- Patients may have decreased corneal sensation from 10 min after exposure to up to 1-2 hours and should be instructed to wear sunglasses or eyeware for protection.[6]
Pulmonary
- Patients with underlying respiratory disease such as COPD and asthma may experience shortness of breath or wheezing. To evaluation for Chemical pneumonitis a chest X-ray may be useful.
- Bronchoconstriction can be improved with inhaled beta-2 agonists such s albuterol
ENT
- Nasal and pharyngeal erythema and irritation will resolve quickly after decontamination
- Laryngospasm lasting up to 45 seconds has been described[7]
Dermatologic
- Patients may experience transient dermatitis and allodynia which will self resolve[8]
Management
Treatment should be consistent with any specific injuries that are identified. Injuries that require treatment are generally only:
Ophthalmologic
- Evaluate and treat any corneal abrasions
Pulmonary
- Patients with evidence of wheezing and bronchospasm may benefit from albuterol therapy
ENT
- Most pharyngitis and mucosal irritation will self resolve
Dermatologic
- Cool water exposure to any irritated or erythematous areas may help reduce cutaneous pain.
Disposition
Patients can generally be discharged. Only those with severe respiratory complaints may require a longer observation period in the Emergency Department
See Also
External Links
References
- ↑ Object of Interest: Pepper Spray. The New Yorker http://www.newyorker.com/tech/elements/object-of-interest-pepper-spray
- ↑ Yeung MF, William YM. Clinicopathological effects of pepper (oleoresin capsicum) spray. Hong Kong Med Journal 21(6). 2015
- ↑ Reilly CA, Crouch DJ, Yost GS, Fatah AA. Determination of capsaicin, dihydrocapsaicin, and nonivamide in selfdefense weapons by liquid chromatography–mass spectrometry and liquid chromatography–tandem mass spectrometry. J Chromatogr A 2001;912:259-67.
- ↑ Steffee CH et al. Oleoresin capsicum (pepper) spray and “in-custody deaths.” Am J Forensic Med Pathol 1995;16:185-92.
- ↑ Zollman TM, Bragg RM, Harrison DA. Clinical effects of oleoresin capsicum (pepper spray) on the human cornea and conjunctiva. Ophthalmology 2000;107:2186-9.
- ↑ Epstein RJ, Majmudar PA. Pepper spray in the eye. Ophthalmology 2001;108:1712-3.
- ↑ Smith CG, Stopford W. Health hazards of pepper spray. Available from: http://duketox.mc.duke.edu/pepper%20 spray.pdf. Accessed 1 Dec 2014.
- ↑ Kennedy WR, Vanhove GF, Lu SP, et al. A randomized, controlled, open-label study of the long-term effects of NGX-4010, a high-concentration capsaicin patch, on epidermal nerve fiber density and sensory function in healthy volunteers. J Pain 2010;11:579-87.
