Post on 19-Dec-2015
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
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
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