SCREENING AND SAFETY SCREENING AND SAFETY IN IBOGAINE PATIENTSIN IBOGAINE PATIENTS

CLARE WILKINS-DIRECTOR, CLARE WILKINS-DIRECTOR, IBOGAINE ASSOCIATIONIBOGAINE ASSOCIATION

STRATEGIESSTRATEGIES

PreparationPreparationDevelop situational attentionDevelop situational attention

Stimulate team workStimulate team workCompensate for stressful factorsCompensate for stressful factors

ANTICIPATION – PLANNING – OPTIMIZATION - INFORMATION

< MORBIMORTALITY> WELL-BEING OF THE PATIENT> CARE QUALITY

The cardiopulmonary function & the The cardiopulmonary function & the psychological state must be psychological state must be

evaluated constantlyevaluated constantly

Objectives of the Evaluation:Objectives of the Evaluation:

Relationship between Relationship between doctordoctor-patient: To -patient: To be a comfortable experience; to be aware be a comfortable experience; to be aware

of all current illness and comorbidities of all current illness and comorbidities MEDICAL HISTORY and MEDICAL HISTORY and

PARACLINICALS (Laboratory and PARACLINICALS (Laboratory and Electrocardiogram)Electrocardiogram)

Therapeutic plan as a team Therapeutic plan as a team Obtain the informed consent of the patientObtain the informed consent of the patient

MAIN OBJECTIVE:MAIN OBJECTIVE:

SAFETYSAFETY

SCREENINGSCREENING

Contact by Phone & e-mailContact by Phone & e-mailMedical Exam / Para-ClinicalsMedical Exam / Para-Clinicals

Clinical historyClinical historyAnamnesis (medical intake)Anamnesis (medical intake)Psychological examinationPsychological examinationPhysical examinationPhysical examination

Treatment planTreatment plan

SCREENINGSCREENING

CLINICAL HISTORYCLINICAL HISTORY Labor (work)Labor (work) Relatives.Relatives.

- - obesity, sedentarismoobesity, sedentarismo Habits:Habits: - alcoholism ( abstinence sydrome, liver disease).- alcoholism ( abstinence sydrome, liver disease). - nicotinism.- nicotinism. - BZD, Opiáte’s, other drugs (tolerance, Sd abstinence).- BZD, Opiáte’s, other drugs (tolerance, Sd abstinence). Allergies and adverse reactions to medicines:Allergies and adverse reactions to medicines: Allergic reactions Allergic reactions

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

- Food- Food

ScreeningScreening

Personal historyPersonal historyHabits (alcohol, cigaretteHabits (alcohol, cigarettess, drugs), drugs)Use of medicinesUse of medicinesIllnesses (Cardiovascular and respiratory, UTI)Illnesses (Cardiovascular and respiratory, UTI)Allergies and Cx (Surgeries)Allergies and Cx (Surgeries)PregnancyPregnancyAcute Infections Acute Infections

Family Family HHistoryistoryHBP, Diabetes , Heart disease HBP, Diabetes , Heart disease

ScreeningScreening

Illnesses that compromise Illnesses that compromise cardiopulmonary function:cardiopulmonary function:

HEART FAILURE , CORONARY HEART HEART FAILURE , CORONARY HEART DISEASE , ARRHYTHMIAS (cardiac DISEASE , ARRHYTHMIAS (cardiac disorder), PULMONARY VENOUS disorder), PULMONARY VENOUS THROMBOEMBOLISM, VENOUS THROMBOEMBOLISM, VENOUS THROMBOSIS, RENAL FAILURE, THROMBOSIS, RENAL FAILURE,

ACTIVE INFECTIONS, PERIPHERAL ACTIVE INFECTIONS, PERIPHERAL NEUROPATHIES, THYROTOXICOSIS NEUROPATHIES, THYROTOXICOSIS

PHYSICAL EXAMINATIONPHYSICAL EXAMINATION CardiovascularCardiovascular

ArrhythmiasArrhythmias Pulses and peripheral perfusión, circulationPulses and peripheral perfusión, circulation

ThóraxThórax Depth of respiratory movements and respiratory frequencyDepth of respiratory movements and respiratory frequency Use of accesory muscles of respirationUse of accesory muscles of respiration Respiratory sounds ( wheezing, crackles, rhonchi)Respiratory sounds ( wheezing, crackles, rhonchi)

AbdominalAbdominal Distention Distention

ExtremitesExtremites Probable vascular accessesProbable vascular accesses swellingswelling

NeurologicalNeurological Mental stateMental state March and muscular forceMarch and muscular force

General aspectGeneral aspect

Color (paleness, cianosis)Color (paleness, cianosis)Nutritional stateNutritional state

HydrationHydrationMental stateMental state

COMPLEMENTARY TESTSCOMPLEMENTARY TESTS

They detect disorders not suspected by the They detect disorders not suspected by the clinical historyclinical history

IndividualizedIndividualized

LABORATORY ELECTROCARDIOGRAM : The normality in : The normality in

EKG does not exclude coronary heart disease; EKG does not exclude coronary heart disease; there are some abnormalities that lack relevancy there are some abnormalities that lack relevancy in asymptomatic patients.in asymptomatic patients.

LABORATORYLABORATORY

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

Recommendations for a healthy patientRecommendations for a healthy patient SMAC 21 PLUS AND CBC SMAC 21 PLUS AND CBC

WBC (infection)WBC (infection) RBC : Recent Hematocrito-hemoglobin (30 %)RBC : Recent Hematocrito-hemoglobin (30 %) QS (glucose,cholesterol,trig)QS (glucose,cholesterol,trig) TGO, TGP, GGT (liver function)TGO, TGP, GGT (liver function) CREATININE , BUN , UREA (RENAL FUNCTION)CREATININE , BUN , UREA (RENAL FUNCTION) TP,TPT (study of coagulation) TP,TPT (study of coagulation) CARDIAC ENZYMESCARDIAC ENZYMES URINE TESTURINE TEST

ELECTROCARDIOGRAMELECTROCARDIOGRAM ECG ( over 40 years) ?ECG ( over 40 years) ? EVERYONE EVERYONE

Dx, TxDx, TxUsed for the detection of arrhythmias, Used for the detection of arrhythmias,

acute myocardial infarction, electrolytic acute myocardial infarction, electrolytic imbalances and function of the pacemakerimbalances and function of the pacemaker

TREATMENTTREATMENT

PREPARATIONS BEFORE PREPARATIONS BEFORE BEGINBEGINNNING ING

FASTINGFASTING

The gastric emptying of clear liquids delay The gastric emptying of clear liquids delay 1 hour and of solid 6 hours1 hour and of solid 6 hours

Stress, pain, anxiety and opioids delay the Stress, pain, anxiety and opioids delay the emptying emptying

PREMEDICATIONPREMEDICATION

Prophylaxis for gastrointestinal symptomsProphylaxis for gastrointestinal symptoms::

Omeprazol (Anti-Acid, Proton Inhibitor) 20 mg OralOmeprazol (Anti-Acid, Proton Inhibitor) 20 mg OralMeclizine & Piridoxine (antiemetic) 25/50mg OAMeclizine & Piridoxine (antiemetic) 25/50mg OAMetoclopramide (Anti-Emetic,Pro Kinetic)10 mg Metoclopramide (Anti-Emetic,Pro Kinetic)10 mg

OAOA

Monitorization:Monitorization:

The first and most important monitor is the The first and most important monitor is the human observerhuman observer

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

Medicate for nauseaMedicate for nausea660 minutes test dose0 minutes test dose 20-30 minutes full dose 20-30 minutes full dose

Monitorization:Monitorization:

Monitor during the following 12 hours, constantlyMonitor during the following 12 hours, constantly Initiate with BP, pulse and saturation of O2Initiate with BP, pulse and saturation of O2 Note down pulse and saturation of oxygen first 4 Note down pulse and saturation of oxygen first 4

hours every 30 minutes and check BP hours every 30 minutes and check BP dependidependinngg on on clinical judgment clinical judgment

LaterLater,, every 1hr up to completing 12 hours every 1hr up to completing 12 hours Check BP every 8 hrs up to finishing treatmentCheck BP every 8 hrs up to finishing treatment

MONITOR CONSTANTLYMONITOR CONSTANTLY

VVentilationentilationOximetry (saturation) Oximetry (saturation)

A saturation of 90 % can mean a Pao2 of 65 % mm Hg.A saturation of 90 % can mean a Pao2 of 65 % mm Hg. To be trustworthy it needs a good peripheral perfusiónTo be trustworthy it needs a good peripheral perfusión

pulsepulseBPBP

Monitorization:Monitorization:

Check for abstinence symptomsCheck for abstinence symptoms

Rhinorrea, piloerection, mydriasis, Rhinorrea, piloerection, mydriasis, yawning, lacrimation, tremors, hot or cold yawning, lacrimation, tremors, hot or cold

flashes, restlessness , vomiting, flashes, restlessness , vomiting, abdominal cramps, anxiety and muscle abdominal cramps, anxiety and muscle

twitchestwitches