There is another form of edematous tracheobronchitis often of great
severity and grave prognosis, that results from the aspiration of
irritating liquids or vapors, or of certain organic substances such as
peanut kernels, watermelon seeds, etcetera. Tracheotomy should be done
if marked dyspnea be present. Secretions can then be easily removed
and medication in the form of oily solutions be instilled at will into
the trachea. In the Bronchoscopic Clinic many children have been kept
alive for days, and their lives finally saved by aspiration of thick,
tough, sometimes clotted and crusted secretions, with the aspirating
tube (Fig. 10). It is better in these cases not to pass the
bronchoscope repeatedly. If, however, evidences of obstruction remain,
after aspiration, it is necessary to see the nature of the obstruction
and relieve it by removal, dilatation, or bronchial intubation as the
case may require. It is all a matter of "plumbing" i.e., clearing out
the "pipes," and maintaining a patulous airway.
_Tracheobronchial Diphtheria_.--Urgent dyspnea in diphtheria when no
membrane and but slight lessening of the laryngeal airway is seen,
calls for bronchoscopy. Many lives have been saved by the
bronchoscopic removal of membrane obstructing the trachea or bronchi.
In the early stages, pulpy masses looking like "mother" of vinegar are
very obstructive. Later casts of membrane may simulate foreign bodies.
The local application of diphtheria antitoxin to the trachea and
bronchi has also been recommended. A preparation free from a chemical
irritant should be selected.
_Abscess of the Lung_.--If of foreign-body origin, pulmonary abscess
almost invariably heals after the removal of the object and a regime
of fresh air and rest, without local measures of any kind. Acute
pulmonary abscess from other causes may require bronchoscopic drainage
and gentle dilatation of the swollen and narrowed bronchi leading to
it. Some of these bronchi are practically fistulae. Obstructive
granulations should be removed with crushing, not biting forceps. The
regular foreign-body forceps are best for this purpose. Caution should
be used as to removal of the granulations with which the abscess
"cavity" is filled in chronic cases. The term "abscess" is usually
loosely applied to the condition of drowned lung in which the pus has
accumulated in natural passages, and in which there is neither a new
wall nor a breaking down of normal walls. Chronic lung-abscess is
often successfully treated by weekly bronchoscopic lavage with 20 cc.
or more of a warm, normal salt solution, a 1:1000 watery potassium
permanganate solution, or a weak iodine solution as in the following
formula:
Rx. Monochlorphenol (Merck) .12
Lugol's solution 8.00
Normal salt solution 500.
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