AIRS Vaping - Case Entry QCA AQI

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First Name

Last Name

Year of Birth:

Gender:

Role:

Institution/Facility:

Facility Type:

State:

City:

Email recipients:

Patient

Is this a real case?

Sex

Age

Habitus

ASA

Area

History

Asthma

Mood or anxiety disorder

E-cigarette use in the previous 90 days

Reported nicotine use

Reported THC use

Reported CBD use

Symptoms reported at presentation

Duration of symptoms(days)

Any respiratory symptom (check all that apply)

Shortness of breath

Any chest pain

Pleuritic chest pain

Cough

Hemoptysis

Any gastrointestinal symptom (check all that apply)

Nausea

Vomiting

Diarrhea

Abdominal pain

Any constitutional symptom (check all that apply)

Headache

Subjective fever

Chills

Weight loss

Fatigue or malaise

Vital signs

Temperature ≥38°C

Heart rate >100 beats/min

Respiratory rate >20 breaths/min

Oxygen saturation while breathing ambient air

≥95%

89–94%

≤88%

Initial laboratory results

Leukocytosis: WBC > 11

Neutrophil predominance > 80%

Erythrocyte sedimentation > 30

Eosinophil percent < 2%

Median procalcitonin: 0.58 micrograms

Aminotransferase levels > 3 5U/Liter

Initial radiographic findings

Abnormal chest radiograph

Abnormal chest CT

Bilateral infiltrates identified on chest radiograph or CT

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Diagnostic Criteria

Use of e-cigarettes?

Yes No

Pulmonary infiltrate on chest radiograph or ground glass opacities on computerized tomography (CT) scan

Yes No

Elevated WBC count and inflammatory markers (c-reactive protein, erythrocyte sedimentation rate)

Yes No

Absence of pulmonary infection

Yes No

Foamy macrophages containing vitamin E acetate on BAL/lung pathology

Yes No

No evidence of alternative medical causes (e.g., heart failure, rheumatologic disease, cancer)

Yes No

Treatment and Clinical course

Antibiotics for lower respiratory tract infection (check all that apply)

As outpatient

During hospitalization

Glucocorticoids (check all that apply)

Systemic glucocorticoids, oral or intravenous, during hospitalization

Intravenous glucocorticoids

Had clinical improvement documented with use of systemic glucocorticoids

Clinical course (check all that apply)

Hospitalization

Outpatient or ED visit before hospitalization

Duration of hospitalization

Receipt of supplemental oxygen

Receipt of noninvasive positive-pressure ventilation

Intubation and mechanical ventilation

Admission to intensive care unit

Death

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Narrative

E-Cigarette Vaping Associated Lung Injury Description
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Any additional information related to this case:

Vaping Associated AIRS Case

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Patient

History

Symptoms reported at presentation

Vital signs

Initial laboratory results

Initial radiographic findings

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Diagnostic Criteria

Treatment and Clinical course

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