Pediatric Terrorism and Disaster Preparedness: Table 5.7

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Table 5.7. Medical Treatment of Riot Control Agent Exposure

Affected Organ/Symptoms	Treatment
Lungs
Dyspnea	Oxygen
Bronchospasm	Albuterol 0.5% inhaled: <15 kg: 2.5 mg (0.5 mL in 2 mL normal saline). >15 kg: 5.0 mg (1.0 mL in 2 mL normal saline). Ipratropium bromide inhaled^a: >2 yr: 500 µg (1 vial).
Bronchorrhea	Atropine, IV or IM: 0.02 mg/kg/dose (min 0.1 mg). Glycopyrrolate, IV or IM: 0.004 mg/kg/dose (max 0.1 mg).
Eyes
Decontamination	Remove and discard contacts. Copious irrigation with normal saline. If CS powder present, blow out of eyes using fan, avoiding contamination of space downwind.
Pain	Topical anesthetic (tetracaine 1%, proparacaine 1%)^b: 1 drop to each eye (apply before irrigation)
Skin
Decontamination	Copious irrigation with soap and water (may transiently increase symptoms). Do not use bleach (hypochlorite)^c.
Pruritus	Oral antihistamines (H1 receptor blockers): Diphenhydramine 5 mg/kg/day divided into 4 doses or Hydroxyzine 2 mg/kg/day divided into 4 doses or Equivalent medication.
Erythema, dermatitis	Topical steroid preparation, apply sparingly BID to affected area. Mild potency on face and genitalia (e.g., hydrocortisone 1% cream). Moderate to high potency on remainder of body (e.g., hydrocortisone 2% ointment, fluocinolone acetonide 0.025% ointment). Ensure proper decontamination.
Vesicles, bullae	Burn dressings with topical antibiotic (silver sulfadiazine 1%).

Notes: BID = twice a day; IV = intravenous; IM = intramuscular.

^a For severe bronchospasm. Do not give ipratropium bromide to patients with peanut allergy.
^b Do not give to patients with allergy to local anesthetics.
^c Bleach may increase riot agent skin exposure and exacerbate erythema, vesiculation, and blistering.

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