E-cigarette or Vaping Product Associated Lung Injury (EVALI) Presenting As Cardiac Arrest.

E-cigarettes or vaping products became available in the market in 2004. Since then, their use has rapidly increased in all sections of society. They have been increasingly used as a "safer" alternative for combustible cigarettes and as an aid toward smoking cessation. Over time, the acceptability of e-cigarettes in public spaces increased. Lack of regulatory control also led to a rapid rise in the rate of e-cigarette/vaping product users. We report a case of a 35-year-old female who recently switched from conventional cigarettes to e-cigarette usage, and who presented to the emergency department after an out-of-hospital cardiac arrest. She was found to have bilateral extensive nodular ground-glass opacities on a CT angiogram of the chest. She needed non-invasive ventilation and was initially started on broad-spectrum antibiotic treatment for possible pneumonia. Due to a worsening clinical status, e-cigarette or vaping product associated lung injury (EVALI) diagnosis was considered, and she was started on parenteral steroid therapy, leading to rapid recovery in respiratory status. With a tapering course of steroid therapy and cessation of e-cigarette use, there was complete clinical and radiological recovery. This case highlights that EVALI can have varied clinical presentations, and the diagnosis should be considered in anyone who presents with an acute cardio-pulmonary decline and a concomitant history of e-cigarette use.

Assessing Vaping Views, Usage, and Vaping-Related Education Among Medical Students: A Pilot Study.

Background E-cigarette use, or vaping, is known to be associated with potentially life-threatening lung injury, with the Centers for Disease Control and Prevention reporting 2,807 hospitalizations and 68 deaths in the United States due to e-cigarette or vaping-associated lung injury. Vaping is also a risk factor for and is implicated in the spreading of COVID-19. Despite the consequences of vaping, the views and training of medical students regarding vaping is unclear. This study sought to investigate the knowledge and perception of vaping amongst future health care providers. Methods An anonymous, online survey was administered to 259 first through fourth year medical students at Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine via a secure website link in October 2019 and January 2020. The survey consisted of two sections. All participants answered section one, involving nine questions. This first section addressed sociodemographic characteristics, personal views on vaping, rating and impact of vaping medical education, and whether students had ever tried vaping. If students had ever vaped, they proceeded to section two of the survey including nine additional questions. Students that reported no past vaping use ended the survey and did not proceed to section two. Section two focused on evaluating vaping habits of users by questioning age of first usage, use frequency and nature, reasons for first trying and/or continuing to use, plans for quitting, personal impact of use, and current use. Data was analyzed with frequency and percentage distributions. Results Most respondents were of age 18-25 years (66.8%) and female (60.2%). Almost all students (96.5%) were aware of the negative health consequences of vaping. More than two thirds of students (68.7%) rated their vaping medical education as inadequate and the majority (76.1%) indicated their medical school curriculum did not impact their view on the matter. Most students (71.0%) reported a more negative stance on vaping due to recent news and media. Of the respondents, over two thirds (37.5%) vaped at least once and were labeled "vapers." The most commonly stated reason for first trying vaping was recreational (60.8%). Half of vapers (50.5%) admitted to vaping in the past year and most vapers (90.6%) did not think their vaping impacted others. Current vaping use was reported in almost one-third of vapers (32.3%) despite knowing its dangers, and several (6.3%) did not consider vaping dangerous. Conclusion The findings from this pilot study conducted at a single medical school indicate possible deficiencies in vaping education, at least as perceived by the respondents and demonstrated by their vaping-related actions. It is unknown if the stated vaping views and practices of these medical students would be positively impacted by better vaping education or if these practices are generalizable to other students. However, the data suggests there is a need to consider more extensive analyses of medical school curriculums with respect to vaping education and training of students in these and related areas. Recommendations to enhance medical school curriculums include vaping-focused respiratory and gastrointestinal lectures, problem-based case studies on vaping, standardized patient encounters, and a community education program taught by medical students.

EVALI - E-Cigarette or Vaping Product Use-Associated Lung Injury: A Case Report.

The use of electronic cigarettes among the young adult and adolescent population has increased over the past decade. Vaping is the process of inhaling an aerosol that is produced by heating a liquid or wax containing substances, such as nicotine, cannabinoids (e.g., tetrahydrocannabinol (THC), cannabidiol), flavoring, and additives (e.g., glycerol, propylene glycol) using an e-cigarette. A multistate epidemic associated with vaping prompted the Centers for Disease Control and Prevention (CDC) to issue an official health advisory on e-cigarette or vaping product use-associated lung injury (EVALI). EVALI is a diagnosis of exclusion with no specific diagnostic test. We present a case of EVALI before the COVID-19 pandemic time in a 23-year-old immunocompetent male student with an eight-year history of vaping. He presented to the emergency department with fever, shortness of breath, tachypnea, nausea, and diarrhea. The patient had no past medical history. The patient denied illicit drug abuse or known drug allergies. The patient was admitted with a diagnosis of sepsis and pneumonia. The patient's urine drug screen was positive for cannabinoids with a history of vaping. Community-acquired pneumonia due to Legionella, Pneumococcal, Mycoplasma bacteria was ruled out. Influenza A/B, Parainfluenza, Rhino, and Adenoviruses were negative. A computed tomographyscan of the chest showed bilateral infiltrates. He was treated with high dose steroids, empiric antibiotics, high flow oxygen and managed in ICU for seven days. The patient was discharged on tapering doses of steroid and counseled to quit vaping. EVALI outbreak is strongly linked to vitamin E acetate in vaping products. EVALI is a diagnosis of exclusion with a history of vaping and responds well to steroids.