With the increasing use of e-cigarettes among adolescents, explosions involving these devices are a growing concern because they can cause serious injuries.

One such incident, described by Elizabeth Ackley, MD, of the University of Colorado at Denver, Aurora, and her coauthors, involved a 17-year-old youth whose electronic nicotine-delivery systems (ENDS) exploded as he was about to take a puff. He presented with a burned left thumb with sensory loss, reduced motor control, and heavy bleeding. He underwent debridement, multiple antibiotic courses, and six operative procedures that ultimately led to removal of the lateral aspect of his thumb.

Little attention has been given to the risk of e-cigarette blast injuries that can occur when the lithium ion battery powering the device short circuits, Dr. Ackley and her associates emphasized. This can occur with overheating, water exposure, excessive charging, improper charging with incompatible devices, contact with metallic objects such as keys or coins, or damage of the battery.

Mineral oil should be used for initial wound irrigation, the authors advise, and “surgical debridement is the definitive treatment for injuries and should remove any remaining alkaline material from tissues.” Delay use of water-based irrigation until after surgical debridement, and one report suggests probing the wound with litmus paper to ensure the pH is no longer alkaline prior to using water irrigation.

Although there are other talking points pediatricians may use when counseling teens about use of e-cigs and other tobacco products, the authors suggested that “the potential for major and disfiguring injury from ENDS explosions may be a more compelling talking point with teens instead of long-term or other nebulous adverse effects of ENDS and tobacco products.”

Read more about the subject at J Pediatr. 2018. doi: 10.1016/j.jpeds.2017.12.032 .



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