Vaping-Related Lung Injury

The number of people who have developed a lung injury after vaping has hit 1080, the CDC reported on Thursday. In the past week, the number of confirmed and probable cases increased by 275.

The number of fatalities increased from 12 to 18. Additional deaths are under investigation. Health officials said that the epidemic is continuing at a brisk pace and doesn't show signs of slowing. Most, but not all, patients have used products containing tetrahydrocannabinol (THC).

"CDC recommends people refrain from using e-cigarettes and vaping products, particularly those containing THC ... particularly those bought off the street," said CDC principal deputy director Dr. Anne Schuchat.

In preliminary tests, concentrations of THC in affected patients' vaping products have been between 14% and 76%.

This an excellent presentation from the CDC: Outbreak of Lung Injury Associated withE-cigarette Product Use or Vaping

NEJM E-Cigarettes and Vaping-Related Disease Publications

Some CT chest examples on presentation:

ICD Indication for IHD to Prevent SCD

Slide set with Summary 2017 ACC/AHA guidelines


2017 AHA/ACC/HRS Guideline for Managementof Patients With Ventricular Arrhythmias andthe Prevention of Sudden Cardiac Death- these are all 120 pages !

Will This Patient Be Difficult to Intubate?

A previously healthy 27-year-old woman was scheduled for elective cholecystectomy. Examination of her airway demonstrated a modified Mallampati score of 2; however, she was unable to bite her upper lip with her lower incisors.

Is she a difficult airway ? Which test has the best +LR?

As a non- anesthesiologist , I definitely learned something new here. The widely used modified Mallampati score (>or equal then 3) had only a +LR= 4.1. The physical examination findings that best predicted a difficult intubation included a grade of class 3 on the upper lip bite test, +LR = 14

In this systematic review in the September JAMA LN issue, several physical findings increased the likelihood of difficult intubation. The best predictors were an inability to bite the upper lip with the lower incisors, a short hyomental distance, retrognathia, or a combination of findings based on the Wilson score. No risk factor or physical finding consistently ruled out a potentially difficult intubation.

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 An abnormal upper lip bite test, which is easily assessed by clinicians, raises the probability of difficult intubation from 10% to greater than 60% for the average-risk patient