Ver el código de «Pepper spray»

==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.<ref> Object of Interest: Pepper Spray. The New Yorker http://www.newyorker.com/tech/elements/object-of-interest-pepper-spray</ref> 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.<ref>Yeung MF, William YM. Clinicopathological effects of pepper (oleoresin capsicum) spray. Hong Kong Med Journal 21(6). 2015</ref> 

===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<ref>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.</ref>

===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<ref> Steffee CH et al. Oleoresin capsicum (pepper) spray and “in-custody deaths.” Am J Forensic Med Pathol 1995;16:185-92. </ref>

==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===
*[[Asthma exacerbation]]
*[[Caustic keratoconjunctivitis]]
{{Chemical weapon DDX}}

==Evaluation==
''Evaluation is focused on the irritated bodily area which is usually the eyes, throat, and skin, and lungs.<ref>Zollman TM, Bragg RM, Harrison DA. Clinical effects of oleoresin capsicum (pepper spray) on the human cornea and conjunctiva. Ophthalmology 2000;107:2186-9.</ref> ''
===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.<ref>Epstein RJ, Majmudar PA. Pepper spray in the eye. Ophthalmology 2001;108:1712-3.</ref>

===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<ref>Smith CG, Stopford W. Health hazards of pepper spray.  Available from: http://duketox.mc.duke.edu/pepper%20
spray.pdf. Accessed 1 Dec 2014.</ref> 

===Dermatologic===
*Patients may experience transient dermatitis and allodynia which will self resolve<ref>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. </ref>

==Management==
Treatment should be consistent with any specific injuries that are identified.  Injuries that require treatment are generally only:
*[[Corneal abrasion]]
*[[Blepharitis]]
*[[Laryngospasm]]
*[[Chemical pneumonitis]]
*[[Shortness of breath]]
===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==
*[[Chemical weapons]]

==External Links==
*[http://www.smithsonianmag.com/ist/?next=/history/forgotten-history-mace-designed-29-year-old-and-reinvented-police-weapon-180953239/ The forgotten history of Mace]

==References==
<references/>

[[Category:Trauma]] [[Category:Toxicology]]