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
slide3

ANTICIPATION – PLANNING – OPTIMIZATION - INFORMATION

< MORBIMORTALITY

> WELL-BEING OF THE PATIENT

> CARE QUALITY

objectives of the evaluation
Objectives of the Evaluation:
  • 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
screening
SCREENING
  • Contact by Phone & e-mail
  • Medical Exam / Para-Clinicals
    • Clinical history
      • Anamnesis (medical intake)
      • Psychological examination
      • Physical examination
    • Treatment plan
screening1
SCREENING
  • 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
  • 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

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
  • 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
  • Color (paleness, cianosis)
  • Nutritional state
  • Hydration
  • Mental state
complementary tests
COMPLEMENTARY TESTS
  • 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
  • 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
        • 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
  • PREPARATIONS BEFORE BEGINNING
fasting
FASTING
  • The gastric emptying of clear liquids delay 1 hour and of solid 6 hours
  • Stress, pain, anxiety and opioids delay the emptying
premedication
PREMEDICATION
  • 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:

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:
  • 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
  • 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:
  • 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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