Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Wilderness and Rescue Medicine 228

Drug and Alcohol Withdrawal

Alcohol, opioid, or benzodiazepine withdrawal can present a diagnostic challenge on a back- country trip. Some people will jump aboard an offshore boat delivery or sign up for a trek in the wilderness specifically in an attempt to beat their addiction. Symptoms of withdrawal can show up hours or days into a trip when return to port or retracing a route can be difficult or dangerous. Unfortunately, the signs and symptoms of with- drawal can look a lot like heat exhaustion, sea sickness, sepsis, myocardial infarction, or a num- ber of other conditions. A history of long term use with recent discontinuation of an addictive substance is necessary to entertain the diagnosis. A rapid return to baseline when the substance is reintroduced will confirm it. Outside of a specialized treatment program, it is unrealistic to expect to cure your patient’s addiction while operating in a high-risk envi- ronment. The best emergency field treatment for alcohol withdrawal is to allow just enough alcohol consumption to stop the problem. For opioid withdrawal, administer enough opioid to keep symptoms under control. And, the same for benzodiazepine withdrawal. If symptoms are controlled and the scene is safe, evacuation can be accomplished on a non-emergent basis.