November 2019

Abstract 1: Nasal Compression With Merocel vs Nasal Compression With TXA

EMA 2019 November30 Chapters

  1. Introduction3:21
  2. Ultra Summary25:51
  3. Rick’s Rants: Goodbye To EMA7:35
  4. Time To Talk A Little Nerdy: Trial Registration Information - Part II: Reporting Bias14:12
  5. Reflections of a Skeptic: Some Final Thoughts26:53
  6. Farewell1:21

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Timothy R. W. -

I thought it worth pointing out that the “perfume bottle” atomizers referred to in Abstract 1, Nov 2019 should not be used in medical practice because of their very high risk of internal contamination and risk of patient cross contamination. You should use a disposable atomizer or other form of administration to deliver TXA or any other nasal drug in the ED.

“Perfume atomizers” – the bottled medication with a bulb or compressed air supply energy source operate via the Venturi principle. The high pressure air is forced through a constriction at the device tip which creates a negative pressure (Venturi effect) and pulls drug up through a second internal lumen which is fragmented into a fine mist. However at the moment that airflow ceases the liquid within the second internal lumen collapses back into the bottle and creates suction on the second lumen. This results in aspiration of any contaminants at the tip into the second lumen and often into the liquid within the bottle. If you touch the patient with the tip of your atomizer you will contaminate the device with their secretions and these contaminants will probably be aspirated back into the perfume bottle. This has been demonstrated very convincingly in the lab and in clinical trials (see links to abstracts below – others exist). Venturi atomizer cross contamination was implicated as the cause of several TB cases in North Carolina reported in 2001 and another tuberculosis outbreak in Washington state about 10 years later. It has probably caused countless other infections that would be harder to track down than tuberculosis.
If you are still using these in your practice, it is time to take them home for perfume administration and stop using them on your patients.


Tim Wolfe, MD Retired

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EMA 2019 November Full episode audio for MD edition 208:54 min - 157 MB - M4AEMA 2019 November - All Abstracts PDF 335 KB - PDFEMA 2019 November - CME Questions 39 KB - PDFEMA 2019 November Individual MP3s 183 MB - ZIPTime To Talk A Little Nerdy: Trial Registration Information - Part II: Reporting Bias 192 KB - PDF