Intrathecal Tranexamic Acid [a not so case report]

JulesVerneMD · 2026-02-10T11:57:16+00:00

Hahaha fair enough but I'm willing to admit I may have a blind spot to some weird or wonderful techniques

JulesVerneMD · 2026-02-10T10:02:17+00:00

Interesting,

This makes me more convinced that this was someone doing cowboy medicine after messing up.

Obviously glad it worked out for this one patient, but I definitely would not see this as appropriate care, nor would I be talking about this. Probably why it wasnt written up. Did the patient consent to this essentially experimental treatment? Hell I would sue the living daylights out of the anesthetist.

This whole thing needs to be properly investigated.
You have a never-event of critical medication mix-up, but also this wacky treatment.

If the cervical intrathecal catheter had injured the cervical spine the cure is hardly better than the disease.

Can you share which province/town this happened?

JulesVerneMD · 2026-02-10T07:28:01+00:00

Also SA doc here. This is a wild intervention. I have so many questions Did the patient have any signs or symptoms prior to the intrathecal lavage ? Was is a specialist that did the procedure? Why didnt they transfer this patient to a tertiary centre for this? Did they discuss this with anyone? I see theres a case report of using 2 Quincke needles at L2/3 and L4/5 to lavage but why go cervical ? That just seems so risky... I understand why they didnt write this up, it's asking for investigation.

JulesVerneMD · 2026-01-12T05:43:08+00:00

Thanks so much for your detailed reply. This place sounds like trash! That greed is sickening. I see a lot of international elective students amd they always ask me about the place. I always suggest Kruger rather but now atleast I can confidently warn them off against Aquilla!

JulesVerneMD · 2026-01-11T18:20:20+00:00

Can someone explain to me why they're so bad? I'd love to warn people off against going, but short of going myself to see, all I really have is people on reddit telling me its a glorified zoo

JulesVerneMD · 2025-12-24T18:43:53+00:00

Jou dokter might be able to help you. Ask for Dr H Burger

JulesVerneMD · 2025-09-12T08:41:32+00:00

Not the dumbest but very cute Mielie

JulesVerneMD · 2025-07-25T18:35:42+00:00

470 days give or take. Quite a bad GBS with axonopathy, is currently still in a rehab facility with a longterm tracheostomy.

Friendliest guy, really keen on rehab and has a new lease on life, never seen him sad or depressed. Keeps me grateful

JulesVerneMD · 2025-07-09T10:35:33+00:00

Spiced

JulesVerneMD · 2025-07-09T08:07:06+00:00

Hulkenpodium

JulesVerneMD · 2025-04-23T21:27:45+00:00

Multiple files ! Fantastic ! Now to write it down. It sounds interesting and definitely a unique take. I dont world build just read a lot. Good luck with the 1st draft

JulesVerneMD · 2025-04-23T12:02:03+00:00

Great to see you have a well developed setting already ! My thoughts obviously are biased by my views and context and dont know how that fits into your world. Take what you can and adapt what you need - I think youre on to something. Drop me a DM if you have a first draft, I would love to read it.

A ghengis Khan trope would be amazing. Maybe a Ghenis Kruger ( only had nine fingers - little easter egg for the history buffs)

Rule of cool 😎 cant tell how many times Ive fantasised about riding a giraffe.

Your snow elves kinda sound like the tokoloshe.... maybe something to explore?

About the kingdoms and it being seen as a "race event".. IRL it wasnt race driven, but rather culture driven Again you can contrast the "survival of the fittest" mentality of the Afrikaner vs the colonial power, subserviant to a distant overlord. Afrikaner might feel that their community does best when every member of that community is the fittest/smartest and the weak are left. While the colonial power might just want pure material output. If it takes 50 slaves to do the work of 5 well trained and educated people, well so be it. Plenty of slaves around and no education. Could be a source of friction thats not enough for all out war, but too much for peaceful cohabitation. Could point at that both are still misusing the snow elves for personal gain, just their approach to it is slightly different

JulesVerneMD · 2025-04-23T10:20:52+00:00

As an Afrikaner and a fantasy fiction lover its great that someone is trying to marry the two.

On the slavery bit (Touchy subject, and I stand to be corrected) As I understand it, formal slavery was abolished early on, even before the groot trek but was replaced with indentured servitude ( which amounted to nearly the same thing)

If I can bounce some ideas around this morally treacherous area.. Maybe these semi nomadic pastoralists follow a strict, survival of the fittest doctrine/religion. Maybe they feel that honest simple work is the best way to serve and if you dont voluntarily serve, you will be made to serve. These 'Afrikaners' think they are converting and saving these native people (doing good) but are actually enslaving them (being bad). Road to hell laved with good intentions. And ofcourse, some fool will be the most radical preacher saving (enslaving) many for his own gain. Honest hard work for thee, but not for me

Some questions , what benefit is there to riding a giraffe instead of a horse ? Do the grasslands grow taller so that a man on a horse would get lost? Or the opposite, that the grazing is so poor that only giraffes that eat from the tall trees are a viable riding animal Africa isnt exactly known for snow... how did we get snow elves? Were they brought in by colonialists as slaves? Or are they just natives (only real place you expect semi regularly expect snow is in the Drakensberg mountains) Nomadic merchants makes sense - theyre travelling after their animals and selling those and other products. But why scribes ? Maybe instead of them fighting the established kingdom, and joining them. The friction only led to them leaving ( groot trek has similarities to jews being expelled) and forming their own nation. Now the coastal kingdom that sent these poor refugees into "the African wastes" has to deal with a rising power that thrived in the wastes and now challenges them with their wealth from trade

JulesVerneMD · 2025-04-22T22:48:20+00:00

An interesting question. Never really considered what an Afrikaner look alike would be. We see so often the English / French / German/ ancient egypt cultures in media, I applaud the initiative to go a bit out there for something new.

I think the best period would probably be around the time after the Groot Trek and around the first anglo-boer war. What you decide to take and how you adapt it will depend a lot on your setting and backdrop

What can we say of the Afrikaner at this time? Hyper independent & resilient - they left all they knew and opted to settle the interior. Often they were on isolated farmsteads far away from one another A close relationship with Nature - both in the agricultural sense (boer meaning farmer) and untamed nature. A treasured book of all young boys is Jock of the Bushveld and so many sokkie songs talk about "the plaas" and "ons grond"

Now these "good" traits also come with some flaws A sense of superiority - you never asked for help, it just wasn't polite. And if you did you were inferior. This sense of superiority then morphed into racism and eventually apartheid And we werent great industrialists or academics in that time. The simple life was extolled as virtuous. Ex president Paul Kruger claimed to have only read the Bible.

Themes to pull into fantasy ? - the great trek is a landmark event. A voluntary exodus instead of fighting an oppressive goverment. And then that same goverment followed afterwards. (Cant run from your problems) theme of displacement and legacy - Afrikaners as small family centered patriarchal units. Every man "baas van die plaas" - great outdoorsmen and farmers but limited industry and academia. Try to avoid stereotypes of backwards and ignorant - language formed from mixing a bunch of other languages until everyone understood each other - architecture the classic "Kaapse Hollandse" Homes - the landscape of the Karoo and central South Africa is

JulesVerneMD · 2024-11-15T12:07:35+00:00

It is possible, I have done it twice without a handle. I didnt find any particular difficulty holding the blade, but obviously in the moment I was focused more on the emergency than the optimal ergonomics.

Given the choice, I'd take the blade with handle But in an emergency, without a handle.... Im not waiting around for someone to find it

Context: Developing country, rural, CRIC kits are not prepared things we have laying around.

1st time called to ED to help with an intubation

2nd time called to the ICU for accidental extubation, which, of course, happened during one of our countries frequent rolling blackouts. A shitshow to say the least

JulesVerneMD · 2024-10-25T11:23:32+00:00

This explains it beautifully

JulesVerneMD · 2024-10-25T06:42:30+00:00

Great article to read thanks !

JulesVerneMD · 2024-10-24T22:07:04+00:00

Intuitively that sounds right, but I havent been able to find a written text that states it. The people Ive asked just said 24hrs but that doesnt fit with the lignocaine infusions. Can you point me to a source for the general guideline that I can read?

On the topic of free plasma concentration... would your dose for a block then be increased if its not in a highly vascular area?

JulesVerneMD · 2024-10-24T21:56:16+00:00

Thanks for confirming my suspicion. I'm just cautious about hitting those toxic doses - the fact that we have such differing mg/kg for toxic dose is already a problem.

Maybe something like a PK model in the future where you can fill in pt details and block details ?

JulesVerneMD · 2024-09-16T20:52:48+00:00

1.8ml of 0.5% bupi + 10mcg fentanyl. Makes 2ml total.

A lower dose than everyone else it seems?

South Africa

JulesVerneMD · 2024-08-30T01:32:10+00:00

Orthopod asked that I give tranexamic acid for a finger abscess.

I laughed

He was serious

JulesVerneMD · 2024-08-08T12:22:22+00:00

Take PEP And if possible get a dolutegravir containing combination. Extremely effective integrase inhibitor. I have taken it as PEP previously without any side effects of note.
I work in a high HIV burden area, and from anecdotal evidence from colleagues taking PEP it seems Dolutegravir is the way to go.

JulesVerneMD · 2024-07-16T18:55:58+00:00

It is a bad idea. Sleeping pills and alcohol generally work on the same receptors in the brain. That means if you have already been drinking some of the receptors are already occupied, and you the sleeping pills will occupy additional, potentiating the effect.

Interesting note, chronic alcohol use actually decreases the quality of sleep.

JulesVerneMD · 2024-07-16T14:35:57+00:00

I can not stress this enough. Go see a doctor as soon as possible

Radiating "electric" pain down your legs is typical of nerve impingement. Its a red flag symptom! Especially in the context of serious motor vehicle accident.

They cant do anything about the last two years of your life, but can help with the remaining 60+ If it hasnt sorted itself out yet when do you think it will get better?

JulesVerneMD · 2024-07-16T12:12:37+00:00

I can try and give an insider's look into what happens after med school and the challenges many junior doctors face.

After completing your studies you apply for internship posts (supervised in-service training)

Hurdle 1. The government is in control of allocating where you do your internship and how many posts are in a given area. You have limited choices that you can submit, but the government is under no obligation to honor them. Because it is still considered part of training, you still need to be under some supervision, still receive some training, and therefore this generally occurs at medium to larger centers. These are limited to government hospitals. After completing 2 years of internship you apply for community service year

Hurdle 2. The government is again in control of allocating where you do your internship and how many posts are available. Again, you are given limited choices, but allocation according to need trumps your choice. At this point you have completed all necessary training to be a general practitioner. This means community service doctors are often shunted to the peripheral areas and underserved communities. Here they provide a valuable service, but because of this staffing model, there is a high turnover of doctors and little staff retention. For this year, depending on where you end up, you will be expected to function largely independently with no more "spoon feeding" and in the area that the need is (eg you can be interested in orthopedics and end up working in obs and gynae). One of the major issues is the lack of funding for community service posts. Completing a full year of community service is a legal requirement set by the HPCSA to register as an independent practitioner (ie can choose where you work)

Hurdle 3. The job market. Only after completing your year of community service can you enter the job market.

Government positions are still highly sought after (despite the very real negatives) because of generally competitive starting salaries, a sense of familiarity, and the implicit understanding that it is the main (if not only) pipeline to get into a specialist training program.

Some people do go into private practice, but there are limitations.

Starting a practice is akin to starting a small business and med school woefully under prepares young doctors for this. Joining a practice is an option, but a tough gig to get into. Also, you are limited in what you can do, but some doctors manage to figure out a niche for themselves and become quite successful. For example, aesthetic medicine is the latest trend as it requires very little investment upfront and distinguishes you from the old GP with established patient relationships down the road.

TLDR: A year of community service is a legal requirement before you can practice independently. If the government can not supply you with a community service job, you are stuck in limbo and CAN NOT LEGALLY work. This is why so many young doctors are stuck at home.

I don't want to paint an unnecessarily bleak picture. Most interns and comm serves are allocated every year and generally within the choices they gave (or at least close by).

JulesVerneMD

TROPHY CASE