INTRODUCTION

In the international wilderness and expedition setting, familiarization with commonly prescribed and abused drugs available to a specific region or group of people is important. Expanded urbanization and worldwide travel has increased illegal drug trafficking exponentially. Awareness of prescription medications any expedition team members may be taking is essential. Additionally, the expedition health care provider should be familiar with the poisonous plants, mushrooms, natural toxins, herbal products, and venomous creatures indigenous to the area of exploration and travel.

The poisoned victim may present with a variety of clinical symptoms including dermatologic changes, gastroenteritis, altered mental status, seizures, cardiac dysrhythmias, and respiratory distress. In many cases, during the initial management, the offending agent is unknown. To complicate matters, a large percentage of overdoses involve multiple drugs, making the diagnosis of the primary causal agent more challenging. Accidental environmental exposures and natural toxins may add to or complicate the presentation of a poisoned victim.

In developing countries and in the remote wilderness, access to medicinal agents is limited. Advanced treatment modalities commonly available in industrialized nations (antidotes, ventilators, dialysis equipment, intensive care units) are usually unavailable in underdeveloped countries or in the expedition environment. Therefore, the provider must be resourceful and, at times, creative. Fortunately, the majority of poisonings can be treated by removing the patient form the source of exposure, taking general decontamination measures, and offering supportive care. In adverse weather conditions, providing shelter away from the elements also represents an essential aspect of supportive care.