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Nicotine is a naturally occurring alkaloid found primarily in tobacco. Nicotine delivery methods include cigarettes, pipe and cigar tobacco, smokeless tobacco, electronic cigarettes, nicotine gum, and lozenges. Long-term complications of nicotine use include coronary artery disease, stroke, peripheral vascular disease, thromboangiitis obliterans (Fig. 27.22A), chronic obstructive lung disease, and oropharyngeal and pulmonary malignancies. Lighting a cigarette while using supplemental oxygen may cause flash burns (Fig. 27.23). Cigarette smoking also causes staining of nails and teeth due to both direct staining from tar and nicotine as well as vascular vasoconstriction mediated by the nicotine and carbon monoxide present in tobacco smoke (Fig. 27.22B). More recently, the increased use of electronic cigarettes (vaping) has resulted in a rise in e-cigarette– and vaping-associated lung injury (EVALI) with typical manifestations of bilateral ground-glass opacities on chest CT (Figs. 27.25 and 27.26).
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Management and Disposition
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Treatment of complications of nicotine use disorder is largely supportive and depends on the specific manifestations presenting. Flash cigarette burns to the face prompt evaluation for airway compromise. Optimal treatment of EVALI is not known, although empiric antibiotics are recommended in addition to close respiratory monitoring, with up to 30% of patients requiring ventilatory ...