Acute lung injury in the setting of vaping is a growing epidemic. Eighty percent of patients experiencing pulmonary complications reported using both nicotine and THC/CBD products. Clinically, patients present with cough, chest tightness, dyspnea and wheezing. Life-threatening complications like hypoxemic respiratory failure and death have also been reported. As of September 26th, 2019, the CDC reported 10 deaths in 12 states attributed to lung injury secondary to vaping. We present a case of likely e-cigarette or vaping product-use associated lung injury (EVALI) with profound hypoxemia with early initiation of vapotherm and intravenous corticosteroids. A 30-year-old male with a past medical history of anxiety, alcohol and tobacco use presented to our institution with one week history of dyspnea, cough and chest tightness. Further history revealed active JUUL/Vape use with THC products. On presentation, the patient was noted to be hypoxemic requiring non-rebreather oxygen (NRB). He was febrile to 101.5 F and tachycardic to 127 bpm. Blood work revealed WBC of 19.2 cells/mm 3 with leftward shift. ABG on NRB 15 liters/minute revealed PaO 2 of 64 mmHg. CT chest revealed diffuse bilateral ground glass opacifications with
Objectives:To study analgesic effect of intracameral Lignocaine in Phacoemulsification under topical anaesthesia, and to report the effect of intracameral Lignocaine on maintenance of pupillary dilatation. Method: An observational study was conducted on 75 patients undergoing Phacoemulsification in cataract surgery; out of which 37 patients were enrolled in control group (treated with topical anaesthesia Only) and 38 patients in test group (treated with topical anaesthesia supplemented with Intracameral Lignocaine). Pupillary diameter was measured before surgery and at the completion of surgery. When the patients returned to recovery room after Phacoemulsification, the patients were asked to fill a pain assessment scale (VAS with numerical rating scale) and data were collected; side effects like ocular itching, burning sensation, as well as effect on maintenance of Pupil Diameter, Haemodynamic Parameters such as syatolic and diastolic blood pressure and heart rate were recorded. Results: Patients' pain experience in control and test group was 62% and 21% respectively. There was no report of any side effect like ocular itching, burning sensation, and also on Haemodynamic parameter such as SBP, DBP, and HR. Pupil diameter before treatment was 8.03mm ±0.15 and 8.16mm±0.17 in control and test group respectively. Pupil diameter after treatment was 5.92 mm±0.20 and 6.80 mm±0.22 in control and test group respectively, indicating better maintenance of dilatation in test group. Discussion: Patients' experience of pain was less and Pupil diameter at the completion of surgery was more in test group as compared to control group. Conclusion: Topical anaesthesia along with intracameral Lignocaine helps to reduce pain to more degree and avoid discomforts during Phacoemulsification in cataract surgery as compared to Lignocaine alone.
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