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SCREENING AND SAFETY IN IBOGAINE PATIENTS

This article discusses the importance of thorough screening and safety measures in patients undergoing ibogaine treatment. It covers preparation, team work, and stress management to ensure the well-being of the patient. The evaluation includes medical history, physical examination, and lab tests. Safety screening involves contact, medical exams, clinical history, psychological examination, and treatment planning. Monitoring during the treatment is crucial for the patient's safety, including constant vital signs, medication for nausea, and regular check-ups.

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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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