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Pediatric Terrorism and Disaster Preparedness

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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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 inhaleda: >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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