Pepper spray: Difference between revisions

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===Pulmonary===
===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.


==Management==
==Management==

Revision as of 16:28, 2 September 2016

Background

Pepper (oleoresin capsicum) spray is 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:

  1. Capsaicin
  2. Dihydrocapsaicin
  3. Nordihydrocapsaicin
  4. homocapsaicin
  5. Homodihydrocapsaicin

Capsaicin and dihydrocapsaicin constitute 80-90% of pepper spray[3]

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

Chemical weapons

Evaluation

Evaluation is focused on the irritated bodily area which is usually the eyes, throat, and skin, and lungs.[4]

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.[5]

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.

Management

Treatment should be consistent with any specific injuries that are identified. Treat any:

Dermatological

Death Associated with Pepper Spray

  • Patient with excited delirium, placed in physical restraint (handcuffed in prone position) with a history of chronic bronchitis experienced asphyxia due to bronchospasm<Steffee CH, Lantz PE, Flannagan LM, Thompson RL, Jason DR. Oleoresin capsicum (pepper) spray and “in-custody deaths.” Am J Forensic Med Pathol 1995;16:185-92. </ref>

Disposition

See Also

External Links

References

  1. Object of Interest: Pepper Spray. The New Yorker http://www.newyorker.com/tech/elements/object-of-interest-pepper-spray
  2. Yeung MF, William YM. Clinicopathological effects of pepper (oleoresin capsicum) spray. Hong Kong Med Journal 21(6). 2015
  3. 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.
  4. Zollman TM, Bragg RM, Harrison DA. Clinical effects of oleoresin capsicum (pepper spray) on the human cornea and conjunctiva. Ophthalmology 2000;107:2186-9.
  5. Epstein RJ, Majmudar PA. Pepper spray in the eye. Ophthalmology 2001;108:1712-3.