Vamana Procedure Note (Shodhana)

Date: [Date]

Patient Name: [Patient full name]

DOB: [Date of birth]

MRN: [Medical record number]

Facility/Location: [Facility or location]

Procedure Start Time: [Start time]

Procedure End Time: [End time]

Performing Clinician: [Name, credentials]

Assistants/Attendants: [Names and roles]

Procedure Summary

[One to two sentence summary stating Vamana (therapeutic emesis) was performed for the primary indication, protocol type used (classical / modified), Śuddhi level achieved (Avara / Madhyama / Pravara), and complication status (none / briefly specify)]

Indication and Goals

[Clinical indication and therapeutic goals] (Write 3–5 sentences documenting the Ayurvedic rationale including dosha predominance, with emphasis on Kapha involvement if applicable, and any biomedical diagnosis used by the practice. If prophylactic or seasonal rationale applies, state explicitly.)

Pre-Procedure Assessment

[Consolidated clinical status and focused exam findings including general appearance, hydration status, baseline orientation, airway assessment, and relevant cardiopulmonary and abdominal findings]

• Relevant Medical History: [Pertinent conditions affecting emesis risk including cardiac disease, GERD, peptic ulcer disease, seizure history, aspiration risk]
• Allergies: [Drug, herbal, and food allergies/sensitivities]
• Current Medications: [List, emphasizing anticoagulants, antihypertensives, hypoglycemics, and agents affecting bleeding risk]

Baseline Vitals: BP [value] | HR [value] | RR [value] | Temp [value] | SpO₂ [value] | Weight [value if dose-dependent]

Contraindication Screening:

• Pregnancy status: [negative / positive / not applicable / not obtained] — method: [urine test / serum test / LMP-based / other] (If not obtained, state reason.)
• Active GI bleeding risk: [present / absent / uncertain] — [supporting findings]
• Significant cardiac disease: [present / absent / uncertain] — [specify if decompensated]
• Aspiration risk: [elevated / average / mitigated] — [factors and mitigation]

Eligibility Determination: [Eligible / Deferred] — [brief rationale]

Pūrvakarma Completion: (If documented elsewhere, cross-reference and confirm readiness only.)

• Dīpana–Pācana: [agents, dosing, completion status]
• Snehapāna: [ghṛta/oil agent], final dose [dose on day], samyak snigdha lakṣaṇa: [yes / no / partial]
• Abhyanga and Svedana: [date/time performed]
• Readiness: [ready for Vamana / not ready] — [rationale]

Informed Consent

• Consent obtained: [yes / no] on [date/time]
• Consenting party: [patient / surrogate (relationship)]
• Discussion: [Procedure, expected benefits, risks (aspiration, dehydration, vasovagal events, electrolyte disturbances), and alternatives explained; questions addressed]

Pre-Procedure Verification

• Time-out performed: [yes / no] at [time]
• Verified: [correct patient / correct procedure (Vamana) / NPO status / safety equipment ready (suction, monitoring)]

(If time-out not performed, document reason and mitigation.)

Medications and Materials Administered

• Vāmaka yoga: [name/compound] (ingredients: [list if compounded]) — dose: [value], route: oral, time: [HH:MM], lot/preparation reference: [details]
• Akaṇṭhapāna: [substance] — total volume: [mL], time span: [start–end]
• Supportive liquids: [e.g., Yaṣṭimadhu phāṇṭa, Saindhava jala] — volume: [mL], time: [HH:MM]
• Additional facilitation: [throat stimulation / back patting / warm water sips / other] (If used, specify method and timing.)
• Rescue/support agents: [ORS / laja manda / IV fluids / oxygen] — dose: [value], route: [route], time: [HH:MM], indication: [reason] (Include only if used.)

Procedure Course

[Technique narrative describing patient positioning, supports provided, sequence of administration, facilitation methods, and observation approach]

Monitoring: [continuous / intermittent] (If detailed vitals in flowsheet, reference here: [flowsheet location]. Include only clinically significant events below.)

• [Clinically significant event/intervention with time and response] (Add entries as applicable.)

Output Summary: Total vega count: [n] | Vomitus volume: [mL] | Input volume: [mL] | Character: [Kapha/Pitta predominance, notable contents] (State estimation method if not directly measured.)

Endpoint Assessment

• Vaigikī (bouts): [count]
• Mānikī (quantity): [volume]
• Āntikī (end sign): [e.g., pitta appearance / terminal sign absent]
• Laiṅgikī (clinical signs): [lightness / clarity / symptom relief / other observed signs]

Śuddhi Level: [Avara / Madhyama / Pravara]

Procedure Quality: [Samyak / Ayoga / Atiyoga / Indeterminate]

[Two to four sentence rationale referencing criteria above. If indeterminate due to premature termination or adverse event, document reason and plan.] (Do not infer; base classification solely on documented findings.)

Immediate Post-Procedure Care

Post-procedure Vitals: BP [value] | HR [value] | RR [value] | Temp [value] | SpO₂ [value] at [time]

• Immediate measures: [oral/face washing / rest positioning / dhūmapāna / kavala] (If standard measures not performed, state why.)
• Hydration status: [assessment] | PO restriction: [duration per protocol]
• Disposition: [home / observation / transfer] — condition: [stable / improved / other]

Complications

[No complications observed.]

(If complications occurred, replace above with structured entries below:)

• Complication: [event] — onset: [time]; signs/symptoms: [details]; category: [Ayoga-related / Atiyoga-related / vasovagal / dehydration / bleeding concern / other]; intervention: [action taken]; response: [patient response]; escalation: [none / consultation / transfer] (Document if procedure stopped early and reason.)

Post-Procedure Plan

• Saṃsarjana Krama: [Peyādi / Tarpanādi / Rasa] for [duration] days — [dietary progression summary] (Note modifications for comorbidities.)
• Parihāra Viṣaya: [duration] days — restrictions: [exertion / travel / temperature extremes / daytime sleep / suppression of natural urges]
• Medications: [Shamana medicines with names and doses]; hydration: [plan]
• Follow-up: [date/time] with [clinician]
• Return Precautions: Seek immediate care for persistent vomiting, inability to retain fluids, blood in vomit, black/tarry stools, severe dizziness, syncope, chest pain, shortness of breath, fever, or worsening abdominal pain. Emergency contact: [per facility protocol]