Screening and safety in ibogaine patients
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SCREENING AND SAFETY IN IBOGAINE PATIENTS. CLARE WILKINS-DIRECTOR, IBOGAINE ASSOCIATION. STRATEGIES. Preparation Develop situational attention Stimulate team work Compensate for stressful factors. ANTICIPATION – PLANNING – OPTIMIZATION - INFORMATION. < MORBIMORTALITY

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Screening and safety in ibogaine patients

SCREENING AND SAFETY IN IBOGAINE PATIENTS

CLARE WILKINS-DIRECTOR, IBOGAINE ASSOCIATION


Strategies
STRATEGIES

  • Preparation

  • Develop situational attention

  • Stimulate team work

  • Compensate for stressful factors


ANTICIPATION – PLANNING – OPTIMIZATION - INFORMATION

< MORBIMORTALITY

> WELL-BEING OF THE PATIENT

> CARE QUALITY



Objectives of the evaluation
Objectives of the Evaluation: be evaluated constantly

  • Relationship between doctor-patient: To be a comfortable experience; to be aware of all current illness and comorbidities

  • MEDICAL HISTORY and PARACLINICALS (Laboratory and Electrocardiogram)

  • Therapeutic plan as a team

  • Obtain the informed consent of the patient


Main objective
MAIN OBJECTIVE: be evaluated constantly

SAFETY


Screening
SCREENING be evaluated constantly

  • Contact by Phone & e-mail

  • Medical Exam / Para-Clinicals

    • Clinical history

      • Anamnesis (medical intake)

      • Psychological examination

      • Physical examination

    • Treatment plan


Screening1
SCREENING be evaluated constantly

  • CLINICAL HISTORY

  • Labor (work)

  • Relatives.

    - obesity, sedentarismo

  • Habits:

  • - alcoholism ( abstinence sydrome, liver disease).

  • - nicotinism.

  • - BZD, Opiáte’s, other drugs (tolerance, Sd abstinence).

  • Allergies and adverse reactions to medicines:

  • Allergic reactions

  • -Medicines: antibiotics, NSAI, Antidepressants, Muscle Relaxants (succinilcolina),

  • - Food


Screening2
Screening be evaluated constantly

  • Personal history

    • Habits (alcohol, cigarettes, drugs)

    • Use of medicines

    • Illnesses (Cardiovascular and respiratory, UTI)

    • Allergies and Cx (Surgeries)

    • Pregnancy

    • Acute Infections

  • Family History

    • HBP, Diabetes , Heart disease


  • Screening3
    Screening be evaluated constantly

    Illnesses that compromise

    cardiopulmonary function:

    • HEART FAILURE , CORONARY HEART DISEASE , ARRHYTHMIAS (cardiac disorder), PULMONARY VENOUS THROMBOEMBOLISM, VENOUS THROMBOSIS, RENAL FAILURE, ACTIVE INFECTIONS, PERIPHERAL NEUROPATHIES, THYROTOXICOSIS


    Physical examination
    PHYSICAL EXAMINATION be evaluated constantly

    • Cardiovascular

      • Arrhythmias

      • Pulses and peripheral perfusión, circulation

  • Thórax

    • Depth of respiratory movements and respiratory frequency

    • Use of accesory muscles of respiration

    • Respiratory sounds ( wheezing, crackles, rhonchi)

  • Abdominal

    • Distention

  • Extremites

    • Probable vascular accesses

    • swelling

  • Neurological

    • Mental state

    • March and muscular force


  • General aspect
    General aspect be evaluated constantly

    • Color (paleness, cianosis)

    • Nutritional state

    • Hydration

    • Mental state


    Complementary tests
    COMPLEMENTARY TESTS be evaluated constantly

    • They detect disorders not suspected by the clinical history

    • Individualized

    • LABORATORY

    • ELECTROCARDIOGRAM : The normality in EKG does not exclude coronary heart disease; there are some abnormalities that lack relevancy in asymptomatic patients.


    Laboratory
    LABORATORY be evaluated constantly

    • They must be chosen according to the medical condition of the patient

    • Recommendations for a healthy patient

    • SMAC 21 PLUS AND CBC

      • WBC (infection)

      • RBC : Recent Hematocrito-hemoglobin (30 %)

      • QS (glucose,cholesterol,trig)

      • TGO, TGP, GGT (liver function)

      • CREATININE , BUN , UREA (RENAL FUNCTION)

      • TP,TPT (study of coagulation)

      • CARDIAC ENZYMES

      • URINE TEST


    Electrocardiogram
    ELECTROCARDIOGRAM be evaluated constantly

    • ECG ( over 40 years) ?

    • EVERYONE

  • Dx, Tx

  • Used for the detection of arrhythmias, acute myocardial infarction, electrolytic imbalances and function of the pacemaker


  • Treatment
    TREATMENT be evaluated constantly

    • PREPARATIONS BEFORE BEGINNING


    Fasting
    FASTING be evaluated constantly

    • The gastric emptying of clear liquids delay 1 hour and of solid 6 hours

    • Stress, pain, anxiety and opioids delay the emptying


    Premedication
    PREMEDICATION be evaluated constantly

    • Prophylaxis for gastrointestinal symptoms:

      • Omeprazol (Anti-Acid, Proton Inhibitor) 20 mg Oral

      • Meclizine & Piridoxine (antiemetic) 25/50mg OA

      • Metoclopramide (Anti-Emetic,Pro Kinetic)10 mg OA


    Monitorization
    Monitorization: be evaluated constantly

    The first and most important monitor is the human observer

    • Constant Vitals : HR, Pulse, BP, Respirations.

    • Medicate for nausea

    • 60 minutes test dose

    • 20-30 minutes full dose


    Monitorization1
    Monitorization: be evaluated constantly

    • Monitor during the following 12 hours, constantly

    • Initiate with BP, pulse and saturation of O2

    • Note down pulse and saturation of oxygen first 4 hours every 30 minutes and check BP depending on clinical judgment

    • Later, every 1hr up to completing 12 hours

    • Check BP every 8 hrs up to finishing treatment


    Monitor constantly
    MONITOR CONSTANTLY be evaluated constantly

    • Ventilation

    • Oximetry (saturation)

      • A saturation of 90 % can mean a Pao2 of 65 % mm Hg.

      • To be trustworthy it needs a good peripheral perfusión

  • pulse

  • BP


  • Monitorization2
    Monitorization: be evaluated constantly

    • Check for abstinence symptoms

    • Rhinorrea, piloerection, mydriasis, yawning, lacrimation, tremors, hot or cold flashes, restlessness , vomiting, abdominal cramps, anxiety and muscle twitches


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