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SCREENING AND SAFETY IN IBOGAINE PATIENTS

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

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  1. SCREENING AND SAFETY IN IBOGAINE PATIENTS CLARE WILKINS-DIRECTOR, IBOGAINE ASSOCIATION

  2. STRATEGIES • Preparation • Develop situational attention • Stimulate team work • Compensate for stressful factors

  3. ANTICIPATION – PLANNING – OPTIMIZATION - INFORMATION < MORBIMORTALITY > WELL-BEING OF THE PATIENT > CARE QUALITY

  4. The cardiopulmonary function & the psychological state must be evaluated constantly

  5. 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

  6. MAIN OBJECTIVE: SAFETY

  7. SCREENING • Contact by Phone & e-mail • Medical Exam / Para-Clinicals • Clinical history • Anamnesis (medical intake) • Psychological examination • Physical examination • Treatment plan

  8. 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

  9. 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

  10. 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

  11. 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

  12. General aspect • Color (paleness, cianosis) • Nutritional state • Hydration • Mental state

  13. 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.

  14. 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

  15. ELECTROCARDIOGRAM • ECG ( over 40 years) ? • EVERYONE • Dx, Tx • Used for the detection of arrhythmias, acute myocardial infarction, electrolytic imbalances and function of the pacemaker

  16. TREATMENT • PREPARATIONS BEFORE BEGINNING

  17. FASTING • The gastric emptying of clear liquids delay 1 hour and of solid 6 hours • Stress, pain, anxiety and opioids delay the emptying

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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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