Medical Aspects of Chemical Warfare (2008) - The Black Vault

VesicantsabcFig. 8-14. (a) Bronchoscopic view of the trachea in an Iraniancasualty 3 weeks after exposure to mustard. Severe hemorrhagicbronchitis, mucosal necrosis, and early scarring areapparent. (b) Bronchogram from an Iranian casualty 1 yearafter exposure to mustard. The tip of a 10-mm rigid bronchoscopecan be seen at the upper margin of the figure. Severegeneralized narrowing of the entire tracheobronchial treeis apparent. The casualty presented with dyspnea, cough,hypoxia, and hypercarbia. (c) Bronchoscopic appearance ofthe carina of an Iranian casualty who had been exposed to mustard several years before. There is nearly total occlusion ofthe left main-stem bronchus.Reproduced with permission from: Freitag L, Firusian N, Stamatis G, Greschuchna D. The role of bronchoscopy in pulmonarycomplications due to mustard gas inhalation. Chest. 1991;100:1437–1438.after exposure. The late development is especiallyfrequent with exposures leading to significant bonemarrow depression. Prophylactic administration of antibioticsis contraindicated and leads to the selection ofresistant bacterial infections. Medical personnel shouldvigilantly watch for early signs and symptoms of infection,using Gram stains, and culture and sensitivitytesting to select the most appropriate antibiotic.Treatment for sloughing of the necrotic bronchialmucosa is rigorous percussion, postural drainage, andprovision of humidified air with supplemental moisturizedair or oxygen. Fiberoptic bronchoscopy maybe needed to remove blockage. Bronchospasm withasthma-like symptoms can be a frequent complicationof mustard lung injury. Medications used for bronchospasmare the same as in asthma: beta adrenergic dilators,steroids, and theophylline-type drugs. Althoughsteroid antiinflammatory agents have yet to be shown289