What's Your Diagnosis? Less-Lethal Law Enforcement Weapon Injuries

Welcome to this month’s What’s Your Diagnosis Challenge!

Case Presentation: Less-Lethal Law Enforcement Weapons: Clinical Management of Associated Injuries in the Emergency Department

A 10-year-old girl is brought to your ED with the chief complaint of eye burning and tearing…

The girl was attending a peaceful march downtown when some protestors became violent and began shoving the attendees. Law enforcement responded and dispersed a “gas” into the crowd to clear the area. The girl and her mother remember seeing large cannon-like weapons and then being surrounded by thick smoke. The girl initially had some coughing that improved after they removed themselves from the crowd, but now she has persistent “burning” eye pain and constant eye watering.
On examination, you note mild conjunctival injection bilaterally with persistent tearing. The girl’s pupils are round and reactive to light, and her extraocular movements are intact. You notice traces of powder on the child’s face. Her vital signs are within normal limits, her lungs are clear, and her heartbeat is regular.
What was this patient most likely exposed to? How can you best decontaminate her? How can you protect your staff from secondary exposure? What additional findings should you be looking for on examination? What treatment is needed?

Conclusion

Given the history of seeing “cannon-like” weapons and then smoke, you were concerned that the patient was exposed to tear gas. Since decontamination was not done prior to entrance into the ED, you and the other ED staff who were interacting with the patient donned full personal protective equipment, including eye protection. You started decontamination immediately, with removal of the girl’s clothing and brushing the skin to remove particulate matter and blowing a fan over the exposed skin. You performed a thorough ocular examination as well as a head-to-toe examination to look for secondary trauma from the projectile.

The eye examination was normal, so you brushed the particulate matter from the girl’s eyelids and then started thorough ocular irrigation, which resulted in the resolution of symptoms. The girl was discharged home with no further issues or complications.