Disclosures: Gaurish A. Soni, DO: Nothing to disclose

Case Description: 32-year-old male security guard with no medical history accidentally ignited a pepper spray gun into his mouth while intoxicated. After a short latent period, blood was seen in his mouth and his wife brought him to ED. Exam revealed posterior pharynx laceration. Patient suddenly deteriorated and went into acute respiratory failure and was intubated. Imaging revealed pneumo-mediastinum and subcutaneous emphysema in right lower neck to mediastinum. CT Head negative and CT Chest/Neck confirmed bilateral aspiration pneumonia. EGD complicated by Vfib/arrest with return of spontaneous circulation after 5 minutes of CPR. EGD was normal. Patient with acute hypovolemic shock leading to multi-organ failure with rhabdomyolysis and lactic acidosis. Toxicology advised the amount of propylene glycol in pellet could not be contributing to condition; therefore, concern for systemic capsaicin toxicity. Surgeon consulted for impending right triceps/biceps compartment syndrome and underwent fasciotomy with secondary wound closure. Patient eventually required trach placement. Repeat CT neck with esophageal tear, made NPO, and G-tube placed. Patient began following commands and eventually transferred out of intensive care.

Setting: Tertiary Care Hospital

Patient: 32-year-old male

Assessment/Results: Patient was max-total assist across the board for mobility and self-care/ADLs. Eventually, patient was able to follow commands and tolerated trach capping.

Discussion: The effect of Oleoresin Capsicum (Pepper Spray) upon exposure to the skin/eyes/respiratory system causes severe irritation and can immobilize or subdue the intended target. It is commonly used by law enforcement and comes available as a can or gun. A gun projects the spray greater than 300 feet/second and more than 20 feet. Evidently, this amount of capsaicin is significantly greater versus a handheld spray can.

Conclusion: The effects of direct, close-range ingestion and inhalation of Oleoresin Capsicum have not, to our knowledge, been documented in recent literature. This case illustrates the severe multifaceted complications that can occur as a result of this form of exposure.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-pepper-spray-predicament-close-range-inhalation-and-ingestion-leading-to-multi-system-organ-failure/