Emergency Medicine Docs: How to Prepare for the Vaping Illness “Epidemic”

Vaping health risks include a mysterious cluster of lung illnesses and vaping deaths. Learn the potential causes, symptoms, and questions to ask.

How can your emergency department prepare for the recent epidemic of vaping illnesses?

There have been over 1,300 cases of mysterious lung illnesses related to vaping in 49 states. The official vaping death toll stands at 26 as of October 2019[*].

E-cigarettes and electronic vaping devices were supposed to help traditional smokers kick the habit. But they may be giving adults and teenagers a potentially life-threatening cluster of pulmonary diseases.

To help patients who may be confused and seeking treatment in your Emergency Room, it’s essential for staff to know exactly what to look for.

And that starts with a basic understanding of how vaping works.

What Is Vaping?

An electronic vaping device heats liquid and turns it into steam, or vapor, which the user inhales. 

This method bypasses the burning of tobacco, which sends harmful carcinogens into the lungs, for a quick hit of nicotine. It’s also popularly used with THC products. These skip the burning of marijuana while still providing the psychoactive effects.

However, nicotine and THC are not added to vaping devices alone. Chemicals and solvents are used to dissolve the products for inhalation — and they’re very worrisome.

Juice manufacturers, or companies that make the liquid to fill the vaping devices, can add whatever chemicals they want in this totally unregulated market. Many add flavorings designed to get kids and teens hooked on nicotine. 

Who’s Most Susceptible to the Vaping Health Risks and Illnesses?

Vaping has been an increasingly popular way for teenagers who have never smoked to start.

A 2018 survey showed 21% of high school seniors (roughly 17- to 18-year-olds) vaped within 30 days, a 10% increase since 2017[*].

Reviewing patients treated for vaping illness reveals a pattern. The CDC says most patients are otherwise healthy and[*]:

  • 70% are male
  • 80% of patients are under 35 years old; 15% of patients are under 18 years old.
  • Would be described as a heavy e-cigarette user who may or may not also vape THC products.

These popular products have been used by millions of people worldwide. So what’s causing the widespread public health epidemic now?

What’s Causing the Recent Cases of Lung Illness and Vaping Deaths?

The complete lack of oversight in vaping means no one really knows what’s in them. They could contain both pure and toxic substances.

These alone may lead to pulmonary illnesses. But you also have to consider the degradation these chemicals undergo when heated in an electronic vaping device. These have the potential to create new, even more dangerous compounds.

Then there are the heating coils in the vaping devices. These are made of metal and may release metal particles, which people then inhale. 

The giant clouds emitted upon exhale are no safer. They contain ultra-fine particles, heavy metals, volatile organic compounds (VOCs), and other harmful substances[*].

To complicate issues further, no one substance, solvent, or device has been identified across all reported cases and samples of vaping illnesses.

There are over 20 possibilities the FDA is testing and analyzing, including:

Solvents and Oils (Especially Vitamin E Acetate and Vegetable Glycerin)

To make nicotine and THC ready to vape, it needs to be mixed with a solvent. Those most commonly used oils include vegetable glycerin (which comes from vegetable oil) and vitamin E acetate (an oil derived from vitamin E)[*].

These oils were not created for vaping despite being used as such. Though safe to ingest, they may damage lungs when vaporized (alone or with other harmful chemicals) and inhaled.

As the oil cools down, people may also inhale oil droplets into their lungs instead of vapor. Samples from eight vaping illness cases showed high levels of vitamin E acetate[*]. Then again, over 100 vaping samples did not test positive for it[*].

Cutting Agents Used To Dilute Juice

Counterfeit vaping devices and overseas juice manufacturers thrive in the unregulated vaping market.

Investigators say vaping juice, or e-cigarette fluid, contains at least six groups of dangerous compounds. These cutting agents used by shady companies or illegal manufacturers may help better emulsify nicotine or THC. 

But they mostly just create higher profit margins.

These factors (and more) all make it hard for investigators and researchers to pinpoint the exact reason vaping is so dangerous.

The Vaping Effect On Lungs: Overlapping Symptoms But No Definitive Diagnosis

Physicians are still struggling to identify and treat vaping illness.

Young, otherwise healthy patients present with similar symptoms, including[*][*]:

  • Cough
  • Severe shortness of breath
  • Chest pain
  • Flu-like symptoms such as fever, vomiting, night sweats, and fatigue
  • Bilateral ground-glass opacities, predominantly in the lower lobes

Symptoms persisted several days to several weeks before patients sought medical help.

All patients admitted to using e-cigarettes with nicotine and/or vaping a product with THC within 90 days of admission. Most even vaped during the week they fell ill.

As a result of vaping-related pulmonary illness[*]:

  • 94% of patients were hospitalized
  • 58% required admission to the ICU
  • 32% had to be placed on ventilators

Notes show many were diagnosed with acute respiratory distress syndrome (ARDS).

Unnecessary tests have no benefit and harm everyone.

So who’s responsible for it?

Physicians took lung scans of one patient and noticed what appeared to be a serious viral or bacterial pneumonia[*]. But tests showed no infection or infectious diseases present. 

They then discovered that the fluid in the patient’s lungs contained white blood cells full of fat. These were not believed to have come from the vaping substances. They were considered byproducts of the breakdown of his lung tissue.

New research says these cases may be a rare rash of lipoid pneumonia[*]. 

When oil gets inside the lungs, they begin an immune response to fight off the foreign invaders. This causes inflammation and a build-up of liquids and abnormal immune cells.

Physicians and researchers still don’t know whether patients with vaping injuries will ever recover or if they’ll have lasting lung damage.

 

How To ID Vaping Illness In The Emergency Room

The CDC asks physicians to rule out flu or any other infections before diagnosing a case of vaping-related illness.

Spread information about symptoms to look for. Make sure everyone in your group ED learns who’s most susceptible to vaping illness and the red flags of symptoms.

Ask patients questions about vaping alone. Young patients are reluctant to admit they’re vaping nicotine or marijuana (especially if it’s illegal) in front of a guardian. They’ll be even less forthcoming if they assume they’ll be in trouble with the police.

Create a safe space without judgment or negative consequences. 

Ask questions such as:

  • Do you smoke cigarettes? Do you smoke marijuana? Do you vape? Do you use a vaping device? 
  • If yes, how often?
  • When was the last time you vaped?
  • Do you vape nicotine, THC, or both?
  • Do you refill your cartridges yourself? What do you fill them with? Where do you get your supplies?
  • Do you purchase pre-mixed juice or cartridges from the same place? Have you had prior negative reactions? When? What was similar?

Teens may be unaware of or in denial about the dangers and health risks of vaping. They may not even connect their symptoms with their addictive hobby. 

So explain why all this matters. And educate them about vaping health risks. Many become so scared by their ER trip, they give it up for good.

Even though vaping was designed to be less harmful, the long-term effects of years of vaping unknown chemicals are still unknown.

Physicians hope this recent trend in Emergency Room use for vaping illnesses slows down. But now your medical team is better prepared in the likely case it continues.

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