Medical Student Corner
Vaping as a Growing Health Concern from a North Dakota Emergency Medicine Department Perspective
North Dakota joined the list of 49 states reporting vaping illnesses, known as EVALI (E-cigarette, or Vaping, product use Associated Lung Injury). The state has nine confirmed cases, four probable, and three suspected. A cluster in northeastern North Dakota is under investigation. Nationally, there have been 1,888 cases and 37 deaths attributed to EVALI. Otherwise, healthy males under 35 years old constitute the majority of cases. However, the median age of fatal cases is 53.
Vaping involves inhaling a heated liquid (via an e-cigarette) which contains nicotine, marijuana, or other chemicals. When the vapor cools, oil coats the lungs. THC was used in 86% of cases where product history could be reliably obtained. For an ER patient with suspected EVALI, a detailed history (substances, sources, devices) becomes pertinent.
CDC criteria for EVALI
- E-cigarette use within 90 days prior to symptoms;
- Infiltrates on CXR or opacities on CT;
- No other plausible diagnosis (cardiac, malignancy, rheumatologic), including infection (respiratory viruses, influenza, other respiratory)
Timelines range from days to weeks, presenting with pleuritic, gastrointestinal, and constitutional symptoms in varying orders. They include tachypnea, tachycardia, respiratory distress, bilateral infiltrations, elevated WBCs without eosinophilia and occasional elevated liver transaminases.
Treatment for EVALI is not well established. Several cases have improved with IV corticosteroids. If indicated by the clinical picture, empiric antibiotics and antivirals are reasonable. Threshold for admission and critical care should be low. The case for admission is strengthened by respiratory distress, O2 <95% on room air, or existing comorbidities. One half required ICU admission, and one fifth required mechanical ventilation.
EVALI should be considered in an adolescent or young adult with unclear respiratory, GI, or constitutional symptoms. The CDC recommends against vaping until safer practices (if any exist) are determined. Suspected cases should be reported to local or state health departments. Current reports and guidelines are available here.
Authors: Heather Kaluzniak MS3; Carissa Klarich MS3
Jon Solberg, MD, FACEP, FAWM, DiMM, Chairman Department of Emergency Medicine
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