CLINICAL REVIEW Management of the Effects of Exposure to Tear

Total Page:16

File Type:pdf, Size:1020Kb

CLINICAL REVIEW Management of the Effects of Exposure to Tear CLINICAL REVIEW For the full versions of these articles see bmj.com Management of the effects of exposure to tear gas Pierre-Nicolas Carron, Bertrand Yersin Service of Emergency Medicine, Despite the frequent use of riot control agents by Eur- solvent, and delivered with a dispersion vehicle (a University Hospital Center and opean law enforcement agencies, limited information pyrotechnically delivered aerosol or spray University of Lausanne, 1011 exists on this subject in the medical literature. The solution).45 Tear gases are not currently considered as Lausanne CHUV, Switzerland Correspondence to: P-N Carron effects of these agents are typically limited to minor chemical weapons by Western countries. Since the [email protected] and transient cutaneous inflammation, but serious 1950s, they have been mainly used by law enforcement complications and even deaths have been reported. agencies for crowd control purposes in most European Cite this as: BMJ 2009;338:b2283 doi:10.1136/bmj.b2283 During the 1999 World Trade Organisation meeting countries, including the United Kingdom, France, and at the 2001 Summit of the Americas in Quebec, Germany, and Switzerland. Tear gases are also used exposure to tear gas was the most common reason for in military training exercises to test the rapidity or effi- medical consultations.12 Primary and emergency care cacy of protective measures in the event of a chemical physicians play a role in the first line management of attack. patients as well as in the identification of those at risk of Of the known disabling chemical irritants (of which complications from exposure to riot control agents. In there are more than a dozen), the five that are tradition- 1997 the National Poisons Information Service in Eng- ally used in the European Union are chlorobenzyli- land received 597 inquiries from doctors seeking dene-malononitrile (also known as CS, after the advice about problems related to crowd control.3 Our chemists Corson and Stoughton who first synthesised article reviews the different riot control agents, includ- it), chloroacetophenone (CN or “Mace”), dibenzoxa- ing the most common tear gases and pepper sprays, zepine (CR), oleoresin capsicum (OC), and pelargonic and provides an up to date overview of related medical acid vanillylamide (PAVA) (figure). 6 Diphenylamino- sequelae. chloroarsine (DM or adamsite) is an irritating and har- assing arsenic based agent used in some countries Sources and selection criteria outside the EU. Oleoresin capsicum is a mixture of We searched the following resources for relevant infor- cayenne pepper extracts, of which capsaicin is the mation on the medical toxicity and management of main active ingredient. 47 Its concentration varies acute exposure to tear gas and pepper spray: Medline, from 1% to 15% depending on the mixture. 7 Pepper PreMedline, Embase, CINAHL, SCIRUS, the strength is measured in Scoville heat units, ranging Cochrane Library, ISI Web of Knowledge, Toxnet, from zero for green pepper to 15 million units for pure Google Scholar, and personal archives. We used the capsaicin. 8 Pelargonic acid vanillylamide is a new stan- “ ” “ ” subject headings riot control agents , pepper spray , dardised synthetic variant of oleoresin capsicum used “ ” “ ” “ ” “ lacrimator , tear gas , irritants , incapacitating mainly in Switzerland, Austria, and Germany. 67 agents”, as well as the toxicological terms “chloro- benzylidene-malononitrile”, “chloroacetophenone”, “dibenzoxazepine”, “chlorodiphenylarsine” and “cap- saicin”. We also searched the reference lists for addi- tional articles. The overall evidence supporting the current therapeutic approach to patients exposed to tear gas or pepper spray is of poor quality. What is a tear gas? Tear gases (along with pepper sprays, toxic emetics, and some sedative substances) are among the so called riot control agents.4 A tear gas is actually not a gas at all, but a toxic chemical irritant in the form of powder or Use of tear gas at demonstration at the time of the 2003 G8 drops mixed to variable concentrations (1-5%) in a summit, Lausanne, Switzerland 1554 BMJ | 27 JUNE 2009 | VOLUME 338 CLINICAL REVIEW Cl O H TIPS FOR NON-SPECIALISTS CCCl Medical teams should wear protection for their own CCCN H safety and to prevent secondary contamination HNC Contaminated clothes must be removed; eyes and 2-chlorobenzylidene- 1-chloroacetophenone (CN) affected skin surfaces should be cleaned with water malononitrile (CS) Forpersistentocularsymptoms,ophthalmological Cl assessment is recommended O As For severe pulmonary symptoms, oxygen therapy, β2-mimetics and ipratropium aerosols may be required N C N For pulmonary symptoms, a 24-48 hour stay in H H hospital or a discharge home with detailed Dibenzoxazepine (CR) Diphenylaminochloroarsine (DM) H3CO CH 3 humidity.4 Characteristics common to all agents HO CH2 NH CO(CH2)4 CH CH C CH3 include a rapid onset time and a short duration of H effects, as well as a wide margin of safety between the Capsaicin incapacitating dose (ICt 50, the concentration (C) that causes incapacitation (I) in 50% of individuals after one = Chemical structure of riot control agents minute (t time)) and the lethal dose (LCt 50, the con- centration that causes death (L) in 50% of individuals after one minute).4 The agents differ from one another How do riot control agents work? by their duration of action, their toxicity (chloroaceto- The irritant effects of crowd control agents probably phenone and diphenylaminochloroarsine are more result from the action of chlorine or cyanide groups toxic than chlorobenzylidene-malononitrile or diben- in addition to alkalising compounds (figure). These zoxazepine), and their physical and chemical charac- agents interact with muco-cutaneous sensory nerve teristics (table 1). Current information on toxicity is receptors such as TRPA1 cation channels. 9 The effect largely based on in vitro and animal studies. 4 of oleoresin capsicum is linked to a direct stimulation of type C and Aδ sensory nerve endings, provoking an What are the medical consequences of acute exposure immediate release of the inflammatory P substance. 78 to tear gas and pepper spray? A toxic effect of the solvent methyl-isobutyl-ketone or of certain metabolites has also been documented in There is limited human research on the risks of tear gas animal experimental studies, in particular for chloro- in terms of inducing disability or death. The irritant benzylidene-malononitrile (formation of cyanide and effect of tear gases affects exposed cutaneous and thiosulfate derivatives) and chloroacetophenone (for- mucous membrane surfaces.45 Table 2 summarises mation of hydrogen chloride).71011 the medical complications. Clinical experience and Assessments of the effects of riot control agents must retrospective case studies suggest that the cutaneous take into account the weather (wind, rain, and ambient effect is by far the most serious symptom, including temperature) in addition to the characteristics of the first and second degree burns. 12 13 Even in minor site of deployment (open or closed space) as the effects cases, skin erythema can last several hours. Direct con- of tear gas are enhanced by heat and by high ambient tact with the flame or a hot canister increases the risk of Table 1 | Physical and chemical characteristics of tear gases and pepper spray 47 Time to Duration of action Relative ICt 50 LCt 50 Name Characteristics activation (minutes) potency* (mg/min per m3)† ‡ (mg/min per m3) Chloroacetophenone Apple odour; powder or emulsion; aerosol 3-10 seconds 10-20 1 20-50 8500-25 000 Chlorobenzylidene malononitrile Pepper odour; microparticles; dispersing 10-60 seconds 10-30 5 4-20 25 000-100 000 effect (grenades) Dibenzoxazepine Odourless; aerosol; persists for prolonged Instantaneous 15-60 20-50 0.2-1 >100 000 periods in the environment or on clothes Diphenylaminochloroarsine Odourless or slightly bitter almond odour; Rapid >60 0.5-2 50-100 10 000-35 000 emetic Oleoresin capsicum Pepper odour; persists for prolonged Rapid 30-60 Not applicable Not applicable >100 000 periods in the environment or on clothes; short distance spray *Refers to the irritant effect. †ICt 50=the concentration that causes incapacitation in 50% of individuals after one minute. *LCt 50=the concentration that causes death in 50% of individuals after one minute. BMJ | 27 JUNE 2009 | VOLUME 338 1555 CLINICAL REVIEW pulmonary oedema has been described in recent case 47 Factors influencing the effect of exposure to tear gas studies, but permanent long term lung damage seems Pre-existing conditions and characteristics of the improbable.19 20 Several cases of death have been affected person attributed to the use of chloroacetophenone in con- Asthma fined spaces. Some of the deaths in the 1993 siege on Chronic obstructive pulmonary disease the Branch Davidians in Waco, Texas, were attributed Cardiovascular disease to the use of large amounts of chlorobenzylidene- malononitrile in a confined space.57 Severe hypertension With pepper sprays, the irritant effect is immediate Young children and lasts 30 minutes on average, mainly affecting the Patients over 60 years eyes, skin, and respiratory tract.17 21 Minor side effects Ocular diseases (corneal erosion, respiratory irritability) are described Contact lenses in many case reports.22 The rare deaths that have been Environmental factors documented were caused by bronchospasm, pulmon- ary oedema, or respiratory arrest and occurred mainly Confined space in patients with asthma.6717
Recommended publications
  • Chapter Four – TRPA1 Channels: Chemical and Temperature Sensitivity
    CHAPTER FOUR TRPA1 Channels: Chemical and Temperature Sensitivity Willem J. Laursen1,2, Sviatoslav N. Bagriantsev1,* and Elena O. Gracheva1,2,* 1Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, USA 2Program in Cellular Neuroscience, Neurodegeneration and Repair, Yale University School of Medicine, New Haven, CT, USA *Corresponding author: E-mail: [email protected], [email protected] Contents 1. Introduction 90 2. Activation and Regulation of TRPA1 by Chemical Compounds 91 2.1 Chemical activation of TRPA1 by covalent modification 91 2.2 Noncovalent activation of TRPA1 97 2.3 Receptor-operated activation of TRPA1 99 3. Temperature Sensitivity of TRPA1 101 3.1 TRPA1 in mammals 101 3.2 TRPA1 in insects and worms 103 3.3 TRPA1 in fish, birds, reptiles, and amphibians 103 3.4 TRPA1: Molecular mechanism of temperature sensitivity 104 Acknowledgments 107 References 107 Abstract Transient receptor potential ankyrin 1 (TRPA1) is a polymodal excitatory ion channel found in sensory neurons of different organisms, ranging from worms to humans. Since its discovery as an uncharacterized transmembrane protein in human fibroblasts, TRPA1 has become one of the most intensively studied ion channels. Its function has been linked to regulation of heat and cold perception, mechanosensitivity, hearing, inflam- mation, pain, circadian rhythms, chemoreception, and other processes. Some of these proposed functions remain controversial, while others have gathered considerable experimental support. A truly polymodal ion channel, TRPA1 is activated by various stimuli, including electrophilic chemicals, oxygen, temperature, and mechanical force, yet the molecular mechanism of TRPA1 gating remains obscure. In this review, we discuss recent advances in the understanding of TRPA1 physiology, pharmacology, and molecular function.
    [Show full text]
  • The Emerging Role of Transient Receptor Potential Channels in Chronic Lung Disease
    BACK TO BASICS | TRANSIENT RECEPTOR POTENTIAL CHANNELS IN CHRONIC LUNG DISEASE The emerging role of transient receptor potential channels in chronic lung disease Maria G. Belvisi and Mark A. Birrell Affiliation: Respiratory Pharmacology Group, Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK. Correspondence: Maria G. Belvisi, Respiratory Pharmacology Group, Airway Disease Section, National Heart and Lung Institute, Imperial College, Exhibition Road, London SW7 2AZ, UK. E-mail: [email protected] @ERSpublications Transient receptor potential channels are emerging as novel targets for chronic lung diseases with a high unmet need http://ow.ly/GHeR30b3hIy Cite this article as: Belvisi MG, Birrell MA. The emerging role of transient receptor potential channels in chronic lung disease. Eur Respir J 2017; 50: 1601357 [https://doi.org/10.1183/13993003.01357-2016]. ABSTRACT Chronic lung diseases such as asthma, chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis are a major and increasing global health burden with a high unmet need. Drug discovery efforts in this area have been largely disappointing and so new therapeutic targets are needed. Transient receptor potential ion channels are emerging as possible therapeutic targets, given their widespread expression in the lung, their role in the modulation of inflammatory and structural changes and in the production of respiratory symptoms, such as bronchospasm and cough, seen in chronic lung disease. Received: Jan 08 2017 | Accepted after revision: April 14 2017 Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com Copyright ©ERS 2017 https://doi.org/10.1183/13993003.01357-2016 Eur Respir J 2017; 50: 1601357 TRANSIENT RECEPTOR POTENTIAL CHANNELS IN CHRONIC LUNG DISEASE | M.G.
    [Show full text]
  • Nerve Agent - Lntellipedia Page 1 Of9 Doc ID : 6637155 (U) Nerve Agent
    This document is made available through the declassification efforts and research of John Greenewald, Jr., creator of: The Black Vault The Black Vault is the largest online Freedom of Information Act (FOIA) document clearinghouse in the world. The research efforts here are responsible for the declassification of MILLIONS of pages released by the U.S. Government & Military. Discover the Truth at: http://www.theblackvault.com Nerve Agent - lntellipedia Page 1 of9 Doc ID : 6637155 (U) Nerve Agent UNCLASSIFIED From lntellipedia Nerve Agents (also known as nerve gases, though these chemicals are liquid at room temperature) are a class of phosphorus-containing organic chemicals (organophosphates) that disrupt the mechanism by which nerves transfer messages to organs. The disruption is caused by blocking acetylcholinesterase, an enzyme that normally relaxes the activity of acetylcholine, a neurotransmitter. ...--------- --- -·---- - --- -·-- --- --- Contents • 1 Overview • 2 Biological Effects • 2.1 Mechanism of Action • 2.2 Antidotes • 3 Classes • 3.1 G-Series • 3.2 V-Series • 3.3 Novichok Agents • 3.4 Insecticides • 4 History • 4.1 The Discovery ofNerve Agents • 4.2 The Nazi Mass Production ofTabun • 4.3 Nerve Agents in Nazi Germany • 4.4 The Secret Gets Out • 4.5 Since World War II • 4.6 Ocean Disposal of Chemical Weapons • 5 Popular Culture • 6 References and External Links --------------- ----·-- - Overview As chemical weapons, they are classified as weapons of mass destruction by the United Nations according to UN Resolution 687, and their production and stockpiling was outlawed by the Chemical Weapons Convention of 1993; the Chemical Weapons Convention officially took effect on April 291997. Poisoning by a nerve agent leads to contraction of pupils, profuse salivation, convulsions, involuntary urination and defecation, and eventual death by asphyxiation as control is lost over respiratory muscles.
    [Show full text]
  • * * * Chemical Agent * * * Instructor's Manual
    If you have issues viewing or accessing this file contact us at NCJRS.gov. · --. -----;-:-.. -----:-~------ '~~~v:~r.·t..~ ._.,.. ~Q" .._L_~ •.• ~,,,,,.'.,J-· .. f.\...('.1..-":I- f1 tn\. ~ L. " .:,"."~ .. ,. • ~ \::'J\.,;;)\ rl~ lL/{PS-'1 J National Institute of Corrections Community Corrections Division * * * CHEMICAL AGENT * * * INSTRUCTOR'S MANUAL J. RICHARD FAULKNER, JR. CORRECTIONAL PROGRAM SPECIALIST NATIONAL INSTITUTE OF CORRECTIONS WASIHNGTON, DC 20534 202-307-3106 - ext.138 , ' • 146592 U.S. Department of Justice National Institute of Justice This document has been reproduced exactly as received from the person or organization originating it. Points of view or opinions stated In tl]!::; document are those of the authors and do not necessarily represent the official position or policies of the National Institute of Justice. Permission to reproduce this "'"P 'J' ... material has been granted by Public Domain/NrC u.s. Department of Justice to the National Criminal Justice Reference Service (NCJRS). • Further reproduction outside of the NCJRS system reqllires permission of the f ._kt owner, • . : . , u.s. Deparbnent of Justice • National mstimte of Corrections Wtulringttm, DC 20534 CHEMICAL AGENTS Dangerous conditions that are present in communities have raised the level of awareness of officers. In many jurisdictions, officers have demanded more training in self protection and the authority to carry lethal weapons. This concern is a real one and administrators are having to address issues of officer safety. The problem is not a simple one that can be solved with a new policy. Because this involves safety, in fact the very lives of staff, the matter is extremely serious. Training must be adopted to fit policy and not violate the goals, scope and mission of the agency.
    [Show full text]
  • Nitrous Oxide (N2O) Isotopic Composition in the Troposphere: Instrumentation, Observations at Mace Head, Ireland, and Regional Modeling
    Nitrous oxide (N2O) isotopic composition in the troposphere: instrumentation, observations at Mace Head, Ireland, and regional modeling by Katherine Ellison Potter B.S. Chemistry & Environmental Science College of William and Mary, 2004 SUBMITTED TO THE DEPARTMENT OF EARTH, ATMOSPHERIC, AND PLANETARY SCIENCES IN PARTIAL FULFULLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN CLIMATE PHYSICS AND CHEMISTRY AT THE MASSACHUSETTS INSTITUTE OF TECHNOLOGY SEPTEMBER 2011 © 2011 Massachusetts Institute of Technology. All rights reserved. Signature of Author: _____________________________________________________________ Department of Earth, Atmospheric, and Planetary Sciences 19 August 2011 Certified by: ___________________________________________________________________ Ronald G. Prinn TEPCO Professor of Atmospheric Chemistry Thesis Supervisor Certified by: ___________________________________________________________________ Shuhei Ono Assistant Professor Thesis Co-Supervisor Accepted by: ___________________________________________________________________ Maria T. Zuber E.A. Griswold Professor of Geophysics and Planetary Science Department Head 2 Nitrous oxide (N2O) isotopic composition in the troposphere: instrumentation, observations at Mace Head, Ireland, and regional modeling by Katherine Ellison Potter Submitted to the Department of Earth, Atmospheric, and Planetary Sciences on 19 August 2011 in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Climate Physics and Chemistry Abstract Nitrous
    [Show full text]
  • Ambient Formaldehyde Measurements Made at A
    Ambient formaldehyde measurements made at a remote marine boundary layer site during the NAMBLEX campaign ? a comparison of data from chromatographic and modified Hantzsch techniques T. J. Still, S. Al-Haider, P. W. Seakins, R. Sommariva, J. C. Stanton, G. Mills, S. A. Penkett To cite this version: T. J. Still, S. Al-Haider, P. W. Seakins, R. Sommariva, J. C. Stanton, et al.. Ambient formaldehyde measurements made at a remote marine boundary layer site during the NAMBLEX campaign ? a comparison of data from chromatographic and modified Hantzsch techniques. Atmospheric Chemistry and Physics, European Geosciences Union, 2006, 6 (9), pp.2711-2726. hal-00295970 HAL Id: hal-00295970 https://hal.archives-ouvertes.fr/hal-00295970 Submitted on 6 Jul 2006 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Atmos. Chem. Phys., 6, 2711–2726, 2006 www.atmos-chem-phys.net/6/2711/2006/ Atmospheric © Author(s) 2006. This work is licensed Chemistry under a Creative Commons License. and Physics Ambient formaldehyde measurements made at a remote marine boundary layer site during the NAMBLEX campaign – a comparison of data from chromatographic and modified Hantzsch techniques T.
    [Show full text]
  • Fluorescent Micro Sphere^ U.S
    [111 4,413,070 [451 Nov. I, 3983 [54] PQLYACRQLEIN MICRQSPHERES 4,210,565 7/1980 Emrnons ............................. 526/315 4,230,772 10/1980 Swift et al. .......................... 526/315 [75] Inventor: Alan Rembaum, Pasadena, Calif. 4,267,091 5/1981 Geelhaar et al. ................... 526/315 [73] Assignee: California Institute of Technology, OTHER PUBLICATIONS Pasadena, Calif. “Characteristics of Fine Particles” Chemical Engineer- [21] Appl. No.: 248,899 ing, Jun. 11, 1962, p. 207. E221 Filed: Mar. 30, 1981 Primary Examiner-Wilbert J. Briggs, Sr. Assistant Examiner-A. H. Koeckert [51] Int. (3.3 .......................... C08F 2/54; C08F 16/34 Attorney, Agent, or Firm-Marvin E. Jacobs [52] U.S. Cl. ............................... 523/223; 204A59.21; 435/180; 526/315; 526/303.1; 252/301.36; [571 ABSTRACT 252/62.54; 424/82; 525/377; 525/380; 525/382 Microspheres of acrolein homopolymers and co- [58] Field of Search ........................ 526/315; 523/223; polymer with hydrophillic comonomers such as meth- 435/180 acrylic acid and/or hydroxyethylmethacrylate are pre- 1561 References Cited pared by cobalt gamma irradiation of dilute aqueous solutions of the monomers in presence of suspending U.S. PATENT DOCUMENTS agents, especially alkyl sulfates such as sodium dodecyl 3,105,801 10/1963 Bell et al. ............................ 204/154 sulfate. Amine or hydroxyl modification is achieved by 3,819,555 6/1974 Kaufman ............................. 526/315 forming adducts with diamines or alkanol amines. Car- 3,936,423 2/1976 Randazzo ............................ 526/315 boxyl modification is effected by oxidation with perox- 3,957,741 5/1978 Rembaum ...................... 204/159.15 ides. Pharmaceuticals or other aldehyde reactive mate- 3,988,505 10/1976 Evans et al.
    [Show full text]
  • An Ayurvedic Approach to the Use of Cannabis to Treat Anxiety By: Danielle Bertoia at (Approximately) Nearly 5000 Years Old, Ay
    An Ayurvedic Approach to the use of Cannabis to treat Anxiety By: Danielle Bertoia At (approximately) nearly 5000 years old, Ayurveda is touted as being one of, if not the oldest healing modality on the planet. The word Ayurveda translates from Sanskrit to “The Science of Life” and is based on the theory that each of us are a unique blend of the 5 elements that make up the known Universe and our planet. Earth, air, fire, water and ether all combine together to create our physical form. When living in harmony with the rhythms of nature and in accordance to our unique constitution, health prevails. When we step outside of our nature by eating foods that are not appropriate, exposing ourselves to outside stressors, and by ignoring the power of our internal knowing, we then leave ourselves vulnerable to dis-ease. Doshic theory reveals to us that these 5 elements then combine with one another to create 3 Doshas. Air and Ether come together to create Vata, Fire and Water to create Pitta and Earth and Water to create Kapha. As we take our first breath upon birth, we settle into our Primary, Secondary and Tertiary doshas, also known as our Prakruti. This becomes our initial blueprint, our Health Touchstone if you will, which we will spend our lifetimes endeavoring to preserve. As time and experience march on, we may begin to experience a distancing from this initial blueprint, a disconnect from our true health, also known as our Vikruti. Outside stress, incorrect food choices, our personal karma and incorrect seasonal diet can all contribute to an imbalanced state within the doshas.
    [Show full text]
  • CS Gas Exposure in a Crowded Night Club: the Consequences for an Accident and Emergency Department
    56 Case reports 9 Selbst SM, De Maio JG, Boenning D. Mouth wash poison- 13 Simon HK, Cox JM, Sucov A, Linakis JG. Ethanol ing. Clin Pediatr 1985;24:162-3. clearance in intoxicated children and adolescents present- 10 Wright J. Ethanol-induced hypoglycaemia. Br J Alcohol ing to the ED. Acad Emerg Med 1994;1:520-4. Alcoholism 1979;14:174-6. 14 Gibson PJ, Cant AJ, Mant TGK. Ethanol poisoning. Acta 11 Ricci LR, Hoffman S. Ethanol induced hypoglycaemic Paediatr Scand 1985;74:977-8. J Accid Emerg Med: first published as 10.1136/emj.15.1.56 on 1 January 1998. Downloaded from coma in a child. Ann Emerg Med 1982;1 1:203-4. 15 Pollack CV, Jorden RC, Carlton FB, Baker ML. Gastric 12 Gershman H, Steeper J. Rate of clearance of ethanol from emptying in the acutely inebriated patient. J Emerg Med the blood of intoxicated patients in the emergency depart- 1992; 10: 1-5. ment. J Emerg Med 199 1;9:307-1 1. See also letters on p00 CS gas exposure in a crowded night club: the consequences for an accident and emergency department A Breakell, G G Bodiwala Abstract respiratory problems, seven required supple- A case is reported of deliberate release of mental oxygen. Two of these patients suffered CS gas (O-chlorobenzylidene malononi- from asthma. Clinically none of the patients trile) in an enclosed space and the conse- developed wheeze but one asthmatic patient quences for an accident and emergency required a nebuliser for chest tightness. One department. patient was admitted to hospital with persistent (7AccidEmergMed 1998;15:56-64) chest tightness and sore throat.
    [Show full text]
  • Acrylonitrile
    ACRYLONITRILE This substance was considered by previous Working Groups, in February 1978 (IARC, 1979) and March 1987 (IARC, 1987a). Since that time, new data have become available, and these have been incorporated into the monograph and taken into consi- deration in the present evaluation. 1. Exposure Data 1.1 Chemical and physical data 1.1.1 Nomenclature Chem. Abstr. Serv. Reg. No.: 107-13-1 Chem. Abstr. Name: 2-Propenenitrile Synonyms: AN; cyanoethylene; propenenitrile; VCN; vinyl cyanide 1.1.2 Structural and molecular formulae and relative molecular mass H2 CCHCN C3H3N Relative molecular mass: 53.06 1.1.3 Chemical and physical properties of the pure substance (a) Description: Colourless liquid (Verschueren, 1996) (b) Boiling-point: 77.3°C (Lide, 1995) (c) Melting-point: –83.5°C (Lide, 1995) 20 (d) Density: d4 0.8060 (Lide, 1995) (e) Spectroscopy data: Infrared, nuclear magnetic resonance and mass spectral data have been reported (Sadtler Research Laboratories, 1980; Brazdil, 1991) (f) Solubility: Soluble in water (7.35 mL/100 mL at 20°C); very soluble in acetone, benzene, diethyl ether and ethanol (Lide, 1995; Budavari, 1996) (g) Volatility: Vapour pressure, 13.3 kPa at 23°C; relative vapour density (air = 1), 1.83 (Verschueren, 1996) (h) Stability: Flash-point (open cup), 0°C; flammable; polymerizes spontaneously, particularly in the absence of oxygen, on exposure to visible light and in contact with concentrated alkali (Budavari, 1996) (i) Explosive limits: Lower, 3.05%; upper, 17.0% (Budavari, 1996) (j) Octanol/water partition coefficient (P): log P, 0.25 (Hansch et al., 1995) –43– 44 IARC MONOGRAPHS VOLUME 71 (k) Conversion factor: mg/m3 = 2.17 × ppm1 1.1.4 Technical products and impurities Acrylonitrile of 99.5–99.7% purity is available commercially, with the following specifications (ppm by weight, maximum): acidity (as acetic acid), 10; acetone, 75; ace- tonitrile, 300; acrolein, 1; hydrogen cyanide, 5; total iron, 0.1; oxazole, 10; peroxides (as hydrogen peroxide), 0.2; water, 0.5%; and nonvolatile matter, 100.
    [Show full text]
  • FCC 10, Second Supplement the Following Index Is for Convenience and Informational Use Only and Shall Not Be Used for Interpretive Purposes
    Index to FCC 10, Second Supplement The following Index is for convenience and informational use only and shall not be used for interpretive purposes. In addition to effective articles, this Index may also include items recently omitted from the FCC in the indicated Book or Supplement. The monographs and general tests and assay listed in this Index may reference other general test and assay specifications. The articles listed in this Index are not intended to be autonomous standards and should only be interpreted in the context of the entire FCC publication. For the most current version of the FCC please see the FCC Online. Second Supplement, FCC 10 Index / Allura Red AC / I-1 Index Titles of monographs are shown in the boldface type. A 2-Acetylpyrrole, 21 Alcohol, 90%, 1625 2-Acetyl Thiazole, 18 Alcohol, Absolute, 1624 Abbreviations, 7, 3779, 3827 Acetyl Valeryl, 608 Alcohol, Aldehyde-Free, 1625 Absolute Alcohol (Reagent), 5, 3777, Acetyl Value, 1510 Alcohol C-6, 626 3825 Achilleic Acid, 25 Alcohol C-8, 933 Acacia, 602 Acid (Reagent), 5, 3777, 3825 Alcohol C-9, 922 ªAccuracyº, Defined, 1641 Acid-Hydrolyzed Milk Protein, 22 Alcohol C-10, 390 Acesulfame K, 9 Acid-Hydrolyzed Proteins, 22 Alcohol C-11, 1328 Acesulfame Potassium, 9 Acid Calcium Phosphate, 240 Alcohol C-12, 738 Acetal, 10 Acid Hydrolysates of Proteins, 22 Alcohol C-16, 614 Acetaldehyde, 11 Acidic Sodium Aluminum Phosphate, Alcohol Content of Ethyl Oxyhydrate Acetaldehyde Diethyl Acetal, 10 1148 Flavor Chemicals (Other than Acetaldehyde Test Paper, 1636 Acidified Sodium Chlorite
    [Show full text]
  • Health Impacts of Chemical Irritants Used for Crowd Control: a Systematic Review of the Injuries and Deaths Caused by Tear Gas and Pepper Spray Rohini J
    Haar et al. BMC Public Health (2017) 17:831 DOI 10.1186/s12889-017-4814-6 RESEARCH ARTICLE Open Access Health impacts of chemical irritants used for crowd control: a systematic review of the injuries and deaths caused by tear gas and pepper spray Rohini J. Haar1*, Vincent Iacopino2, Nikhil Ranadive3, Sheri D. Weiser4 and Madhavi Dandu4 Abstract Background: Chemical irritants used in crowd control, such as tear gases and pepper sprays, are generally considered to be safe and to cause only transient pain and lacrimation. However, there are numerous reports that use and misuse of these chemicals may cause serious injuries. We aimed to review documented injuries from chemical irritants to better understand the morbidity and mortality associated with these weapons. Methods: We conducted a systematic review using PRISMA guidelines to identify injuries, permanent disabilities, and deaths from chemical irritants worldwide between January 1, 1990 and March 15, 2015. We reviewed injuries to different body systems, injury severity, and potential risk factors for injury severity. We also assessed region, context and quality of each included article. Results: We identified 31 studies from 11 countries. These reported on 5131 people who suffered injuries, two of whom died and 58 of whom suffered permanent disabilities. Out of 9261 total injuries, 8.7% were severe and required professional medical management, while 17% were moderate and 74.3% were minor. Severe injuries occurred to all body systems, with the majority of injuries impacting the skin and eyes. Projectile munition trauma caused 231 projectile injuries, with 63 (27%) severe injuries, including major head injury and vision loss.
    [Show full text]