What does evaporation do to the body? Is it bad? And if so, how bad? And how does it compare to plain old cigarette smoke? The same, better or worse? We will answer all the questions and of course take out a human lung to help us with this discussion as well as show other organ systems that you may not be able to affect through vaporization. So let's get started in this. [Intro] So I just want to quickly say thank you to the sponsor of this video, Brilliant, as we get into this discussion about vaping .
We put the link in the description below and talk a little more about Brilliant at the end of the video. But when it comes to vaporizing or introducing vapors into the body or cigarette smoke into the body, we just inhale good old-fashioned oxygen – it's very important to understand the pathways these substances will travel on and therefore give us an idea of how it might affect the body. Let's look at the paths on the cadaver here. This is a sagittal cut through the head and it gives us an idea of the upper airways, and if we look here, we can see the nose and the mouth here. Now we can bring in air through the nose, and if it enters through the nose , it will enter a passageway called the nasal cavity. This septum here just divides the nasal cavity into the right and left, but of course we can bring air in there.
Of course, we can also bring in air through the mouth and the oral cavity. But both the nasal cavity and the oral cavity end up going to the same place – this area we refer to as the pharynx, but most of us just call it the throat. But if the vapor or the air passes through the pharynx, we have to go somewhere. There is this fork in the road. The posterior tube is often called the tube or the esophagus, this is not where this stuff goes. We're going to move the air or the vapor into the windpipe, which is the front tube or section that's pretty crazy that you can even see a cadaver. You can see – let me pull it up a little bit higher – that the windpipe stays open, which makes a lot of sense because we're breathing all the time, so the body has created these little cartilaginous rings to keep the windpipe or airways open, where the esophagus doesn't eat 24 hours a day (at least not hopefully) and this thing can collapse between meals and not matter.
But we end up with the trachea on this particular cadaver, so I have to show you another dissection here of a right lung and again the trachea here. Let us orient you – here is the air pipe – the air moves down there, but when we get down here, we have a fork in the road. It is only the right half or the majority of the right half here. It can go left to the left lung or right to the right lung and if it branches here, we call it the bronchi. And as you can see here, they just branch out further into the lung tissue as different types of bronchi or bronchus for singular.
As the bronchi continue to branch, they get smaller and we change the name to bronchioles, and then they go into these things called alveolar sacs that are made up of individual alveoli. This is your little anatomy lesson for how this air is going to go in, but the most important part of this is the alveolar sacs and alveoli, because that's the thinnest, thinnest tissue in the lung or the thinnest part of the tube, just one cell thick. And that's really important because that's where we exchange oxygen and carbon dioxide with the bloodstream, and the alveoli and the bronchioles are usually the most affected when we talk about vaping. So what exactly evaporates? Well? Vaping began with e-cigarettes that were originally designed to vaporize regular cigarettes. However, the technology has changed dramatically in recent years. These devices now tend to be larger, rechargeable, and contain a liquid-filled cartridge . The liquid is then heated by an atomizer which vaporizes the liquid and creates a vapor, hence the name "vaporization".
But is it bad to introduce the vapor into the human body? Well, it certainly can be. You see, in recent years, hospitals have seen an increase in patients with acute lung injury due to vaporization. Now they mentioned using Associated Lung Injury or EVALI, and we'll use EVALI for the rest of the video. But these patients came with symptoms very similar to pneumonia. But what they found is that there was no infectious cause for their symptoms. This means that when they would test, they could not find a viral cause or bacterial cause of their symptoms, but they found that they all have these similarities and that they are recent vaping. So the idea was that something in the cartridge or what was being vaporized was damaging the lungs. But before we think about the products or the substances in the cartridge that cause damage to the lung, I can tell you a little about the symptoms that the patients came in with. Many of the patients had fever, chills and even the generalized icky feeling – also cough, shortness of breath and chest pain and in some cases even hemoptysis – hemoptysis is just a fancy name for coughing up blood, and it makes sense if we ' inhale something that we can affect the lung tissue and have symptoms that could be a lung problem.
However, up to 80% of patients with EVALI would have GI symptoms, meaning they affect the GI tract, and they have things like nausea, vomiting, diarrhea, and general abdominal pain. So the cause… What do they think is in these patterns and therefore the liquid in the vapor that could be linked or could cause EVALI, and therefore the symptoms in these patients? Well, the challenge is that it is not a heavily regulated industry. So the ingredients that one manufacturer may use compared to another manufacturer are not exactly the same. However, they found many common ingredients in these substances, some of which include things like nicotine, which we know can cause dependence on the substance or be addictive, and also contain things like propylene glycol or glycerol.
These are known as wetting agents that moisten the ingredients in the liquid in the cartridge. We're also seeing things like tetrahydrocannabinol, which is THC, even downtown oils, and they 've also found vitamin E acetate. It can also contain more than 7000 flavors, and some have found small traces of metals such as tin, nickel, chromium, manganese and even arsenic. But are some of them more problematic than all the ingredients? Did they find specific links to certain ingredients? And the answer is yes. So let's go back to the hospital example: when clinicians visit these patients, they see tachycardia, tachypnea, which is a fast heart rate, fast breathing, low oxygen saturation, and often get a chest X-ray or CT scan that shows infiltrates in their lung shows or what they refer to as opacity, and the clinicians think "It looks like pneumonia". And then they'd go and do cultures and see no bacterial cause, or they'd do viral panels and couldn't see a viral cause, and that made them think 'What's going on here'? So in some cases they would do this procedure called a bronchoalveolar lavage.
A bronchoalveolar lavage is pretty cool – that's if you take a camera or a fiber optic camera into the airways and then go back down the windpipe, then it will go into these further airways and then you take the tube or the camera the tube of lung tissue or the bronchial tree to see if you can see things. What they would also do is inject saline, which is a kind of saline mixture , into the terminal airways – bronchoalveolar lavage into the bronchioles and alveoli, and then they would literally suck it up and then take the fluid and analyze it to see what they would find.
Again, they found no pathogens, but most people with EVALI found vitamin E acetate and THC. So what do we do with this information about vitamin E acetate and THC? And since when is vitamin E a harmful substance? Well, it's usually not when we use it in lotions and creams and apply it to our skin or even ingest it, but remember that when we ingest and it goes down the feeding tube or the esophagus, it will be processed very differently than if it into the airway or into the trachea and into the respiratory tract and into the lung tissue. The idea is, could it be – this oily kind of thickener that coats the lining of the tube or in the lung tissue that causes inflammatory reaction? Is it interacting with the cells in a different way that is causing a problem? Well, we don't know the exact mechanism yet, so more research is needed. Because of the strong association between vitamin E acetate and patients with EVALI, the CDC recommended that vaping companies not use vitamin E acetate in their products, or that you do not choose a product with vitamin E acetate.
They also recommend that people who don't like these things, unfortunately, stop using products that contain THC because of the link between how many people have found it in their bronchoalveolar lavage and had EVALI. I'm sorry to bear the bad news. So, what is it like for patients with EVALI? Speaking of numbers, the CDC collected data through February 2020 and found that 2,807 people were hospitalized with it. Out of the 2807, 68 people died. If we do the math on it, it's about 2.4%. To be clear, it's not 2.4% of people who vape and die, it's 2.4% of people who get EVALI from vaping. So based on these numbers, the majority of people will recover. Now, while being treated, many of them will be given antibiotics, again because of the close association with pneumonia. Until they can completely rule out pneumonia, they do this as a precaution.
But again, once they confirm that there is no infecting pathogen, the antibiotics aren't going to do anything. And so, we are mostly talking supportive therapy. Some clinicians noted that they had some improvement with their patients by giving anti-inflammatory steroids that could calm the inflammation. A lot of the – most of the patients, I would say, if they're probably going to get supplemental oxygen in the hospital – how much depends on the severity, and as the severity increases, we can knock on the door of things like ventilation. But most patients will have a noticeable improvement in their symptoms within about two weeks .
They may still have some residuals and need a few more weeks to feel fully recovered, but again, during the two to three to four week period, you're probably looking at 'I feel like myself again' ' . We don't know the long-term effects yet. And the last thing we need to talk about – how does vaping compare to plain old cigarette smoking or smoking tobacco? There is general consensus in the medical community that smoking is worse than vaping if you have to choose between the two. While we now have a lot more information about cigarette smoking and its long-term effects when compared to vaping, we don't have many long-term studies because it's such a new thing and we're still trying to figure out the exact mechanism. find how vitamin E acetate and THC affect any valley and those symptoms. But if I gave you an example – let's say a clinician had a patient who said, "Hey, I want to quit smoking" and their patient said, "Can I try vaping instead?" now the clinician would probably say, "I'd rather you not do one and we can use these other medications to manage nicotine dependence in a different way because these medications have a lot more research on their effectiveness and safety." But if the patient is like "No, I don't touch medicine.
It's your choice for me clinician? What are you going to do to me?", the clinician would say, "Ok, quit smoking completely and do vaping". There is a specific recommendation in the CDC that when patients try to use vaping in place of smoking to not mix the two because you just have to get the cigarette smoke out of it and then when we use the vaping, the idea is that we eventually can go to smoking cessation and it is a lesser damage to the actual lung tissue. But what about people who have never smoked and have no intention of smoking, but want to vape or are currently vaping? The recommendation is again: stay away from the vitamin E acetate and the THC. The perfect world scenario is: don't inhale any of these foreign substances into your lung tissue . There is a huge increase in vaping in the younger population, especially high school kids, high school kids, people in their early twenties, and there is great concern that it could be a gateway to cigarette smoking. They do have enough data to show that if you vape, you are more likely to try cigarette smoking, which again is known, even if we were just talking about it, to be more harmful than just vaping.
So I apologize to those who vape and think I'm being a negative Nancy or the bearer of bad news, but you know, we only get two of these organs – these amazing lungs that help us breathe and take in oxygen and carbon to exchange. dioxide, so we should probably take care of that . But if you must vape, avoid vitamin E acetate. And it's probably best that you get THC from a qualified medical professional or by means consistent with your local law. If you are interested in going into the medical field, you need to learn a little more than just anatomy and physiology; you should explore other subjects like chemistry, physics and maths. And so I want to take the time to say thank you to the sponsor of this video, Brilliant.
Brilliant is an interactive online learning platform for core subjects – that is math, logic, science and computer science. Brilliant helps you develop knowledge and problem-solving skills through hands-on lessons so you can think creatively, ask the right questions and apply the information to real-world situations, which is one of the most important things you can do as part of your education process. Brilliant allows you to explore the important topics of chemistry, physics and mathematics, so you can apply them to medicine and the human body – whether it's the physics and dynamics of blood flow or complex chemical reactions at the cellular level, or even weight-based calculations for medicine for a patient, Brilliant has you covered. If you are interested in learning more about these important topics, visit Brilliant.org/instituteofhumananatomy or click on the link we will post in the description below. First 200 people get 20% off their annual subscription to Brilliant. And again, thanks for watching our videos, blast off the comments below and we'll see you in the next video..
