Subglottic Stenosis after High Concentration of Screening Smoke

Abstract

Unlike the sulphonamides, which soon after therapeutic birth began to show occasional reactions, penicillin has maintained a relatively uncloaded reputation. Publication of the following case is therefore of interest. Case HistoryOn Sept. 7, while reconnoitring an enemy-held wood, a tank squadron commander was hit by a fragment of an 88-mm. shell which traversed his tank. The fragment-1l by 1 cm.-which was embedded superficially in his lower lateral right calf, was removed an hour later and a sulphanilamide dressing applied. The officer remained on duty, but on Sept. 19 the leg became painful and the ankle swollen. He was admitted to a field dressing station, where sodium sulphate dressings were applied. On Sept. 24 sodium penicillin solfition was instilled direct into the wound, with a similar application on the following day. On Oct. 2 he was admitted to a casualty clearing station, where a sinus-1 in. long was opened up. Since this officer was a key man urgently required by his unit, undiluted sodium penicillin powder (without sulphonamide vehicle) was applied in a much higher concentration than-is normally employed, in the hope that recovery might be hastened. Similar application was made on Oct. 5. Progress was satisfactory, and on Oct. 10 the wound bad almost completely epithelized. On Oct. 11 the patient intimated that he had a mild chronic bilateral external otitis. At 5 p.m. the same day two drops of sodium penicillin solution (100,000 units in 5 c.cm.) were instilled with a pipette into each ear. By 2 a.m. the next morning both ears were discharging profusely. His leg, previously almost healed, began to weep copiously, and literally saturated a moderately heavy cottonwool dressing. The area affected

The toxicology of zinc chloride smoke producing bombs and screens

“…In addition, a high exposure dose associated with lasting damage to the respiratory system. For example, victims exposed to a dense cloud of ZnCl 2 smoke in a confined space developed subglottic stenosis and restricted pulmonary dysfunction [6,26].…”

“…A total of 23 reports include data from chest radiograph examinations of patients following exposure to ZnCl 2 smoke [5,6,8,[11][12][13][14][15][16][18][19][20][21][22][23][25][26][27][28][30][31][32][33]. These radiographs showed an interesting pattern when ordered chronologically.…”

“…Individuals exposed for longer than two minutes showed a remarkably slower pace of normalization (several months) or incomplete recovery of lung function [18,22,[25][26][27]30,31]. Reports on vital parameters show that virtually all patients exhibited signs of inflammation, such as fever, tachypnoea and tachycardia [6,7,[11][12][13][14][18][19][20]22,23,26,27,30,31,33]. Leukocyte counts were elevated in most cases, with higher levels in severely exposed patients [8,12,15,28,30].…”

“…The treatment regimen for ZnCl 2 smoke-induced injury frequently included antibiotics in order to prevent bacterial infection of damaged lung tissue. In the time period preceding 1985, patients underwent courses of sulfapyridine [6], sulfathiazole [6], penicillin [9,10,12,13], streptomycin [10,12], erythromycin [10], tetracycline [10,11,15], benzylpenicillin [10] and chloramphenicol [15]. After 1985, patients received erythromycin [18], oxacillin [26], gentamicin [26], ceftriaxone [26], ceftazidime [28,31] and levofloxacin [33].…”

“…Although a 1943 publication suggested limited health risks [1], three separate reports published in 1945 illustrated the hazards of ZnCl 2 smoke exposure [5][6][7]. Currently, the scientific literature contains nearly 30 reports on subsequent incidents involving ZnCl 2 exposure ( Table 1).…”