April 23, 2020

Background: Electronic cigarette use, or vaping, has been rising in popularity in the United States. Electronic cigarette use has been associated with respiratory symptoms that have collectively been labeled e-cigarette or vaping product use-associated lung injury (EVALI). In a recent study of mass spectrometry of bronchoalveolar lavage samples, Vitamin E acetate was found in 94% of cases in the EVALI group and was not present in the comparison group [2]. Per the CDC data, the number of hospitalized cases peaked in August and September of 2019. Due to identifying the likely etiology of the lung injury, vitamin E acetate, there has been increased regulation and a subsequent decrease in cases; however, vaping-associated lung injury remains in the potential differential diagnosis for patients presenting to the emergency department with unexplained respiratory symptoms.

December 19, 2019

Background: E-cigarettes or “vapes” are now the most popular tobacco product among US teens and are used by 20% of all high-schoolers2. Vapes are used to heat and vaporize a liquid (e-juice or vape juice) that may contain nicotine, tetrahydrocannabinol (THC), cannabidiol (CBD), or ultraconcentrated THC resin (hash oil, wax, or dabs.)3. Since their introduction, vaping devices have been studied for the numerous potentially harmful chemicals they can introduce into users, including: heavy metals (cadmium, nickel, lead), plastic-related toxic gases (like cyanide and phosgene), volatile organic compounds, ultrafine particles, and diacetyl flavoring (linked to a chronic pulmonary syndrome known as ‘popcorn lung,’ which is not as appealing as it sounds)4. More recently, a spectrum of lung illnesses related to vaping have become the focus of a national public health investigation. These cases have been described in almost every US state since early summer 2019; as of November 2019, there have been over 2000 cases of ‘Vaping-Associated Lung Injury’ (VALI) reported to the CDC, with 42 associated deaths. The article discussed below is a large case series from the Midwest depicting the clinical characteristics and outcomes of patients with VALI from April to August 2019.  Since then, several more epidemiological and analytical investigations have been published, and studies are ongoing to clarify the causes and best treatments for this disorder. We chose this article for REBEL EM because it represents a well-done early investigation of an emerging epidemic which contributed valuable clinical insights for emergency medicine practice.