Publications by authors named "Meghan Spyres"

Article Synopsis
  • The American College of Medical Toxicology's Toxicology Investigators Consortium has been maintaining a national case registry since 2010, documenting patient consultations in hospitals and clinics regarding medical toxicology.
  • In 2023, the registry recorded data from 7,392 patients, bringing the total number of cases since its inception to 102,331 across 36 sites with 61 healthcare facilities.
  • Ethanol emerged as the most common exposure agent in 2023, followed by opioids and non-opioid analgesics, with a reported 98 fatalities (1.3% case fatality rate) and analyses of demographics and trends in toxicology consultations.
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Availability of counterfeit prescription pills (counterfeit pills) containing illegally made fentanyl, including counterfeit M-30 oxycodone (counterfeit M-30) pills, has risen sharply in the United States and has been increasingly linked to overdose deaths. In 2023, approximately 115 million counterfeit pills were seized in U.S.

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Background: Gender diversity in both emergency medicine and medical toxicology has grown over the last decade. However, disparities in promotion, awards, and speakership still exist. No studies have examined gender disparities in authorship in medical toxicology journals.

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Article Synopsis
  • Intravenous lipid emulsion has been proposed as a potential antidote for toxic drug overdoses based on the "lipid sink" theory, which suggests it can help sequester lipophilic drugs in the bloodstream.
  • The study analyzed 134 cases from a toxicology registry to see if the survival rate after lipid therapy was related to the lipophilicity of the intoxicants involved.
  • Results showed that 80.6% of patients survived, but there was no significant link between the intoxicant's lipophilicity and survival; however, systolic blood pressure improved for both groups after treatment.
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Since 2010, medical toxicology physicians from the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC) have provided reports on their in-hospital and clinic patient consultations to a national case registry, known as the ToxIC Core Registry. De-identified patient data entered into the registry includes patient demographics, reason for medical toxicology evaluation, exposure agents, clinical signs and symptoms, treatments and antidotes administered, and mortality. This thirteenth annual report provides data from 7206 patients entered into the Core Registry in 2022 by 35 participating sites comprising 52 distinct healthcare facilities, bringing the total case count to 94,939.

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Introduction: Compartment syndrome (CS) is a rare but serious complication after crotalid envenomation in the United States. Few data are available regarding the epidemiology and management of these cases. Significant controversy and misunderstanding over best practices, including measurement of compartment pressures and use of fasciotomy, exist for this syndrome.

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Article Synopsis
  • The Toxicology Investigators Consortium (ToxIC) Core Registry was established in 2010 to collect data on medical toxicology consultations, with the 2021 report including 8,552 new cases.
  • The report presents detailed information on patient demographics, the reasons for consultations, types of agents involved, clinical symptoms, treatments provided, and fatalities, finding that 120 cases resulted in death.
  • Key findings indicate non-opioid analgesics were the most commonly reported substances, with acetaminophen being the most frequent agent, while fentanyl led to the highest number of fatalities; trends in demographics and exposure characteristics largely mirrored previous years.
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Introduction: Late hemotoxicity is common following rattlesnake envenomation treated with crotalidae immune polyvalent Fab (ovine) (FabAV). Initial clinical trials showed crotalidae immune F(ab')2 (equine) (Fab2AV) to be superior to FabAV in preventing late hemotoxicity, but this effect has not been demonstrated in broader populations. This study investigated late hemotoxicity in patients receiving Fab2AV or FabAV after rattlesnake envenomation.

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Introduction: Crotalidae immune F(ab') (Fab2AV) became available in the USA in 2019 for treatment of rattlesnake envenomation. In the clinical trial comparing Fab2AV to crotalidae immune polyvalent fab (FabAV), Fab2AV was associated with less late hemotoxicity. The purpose of this study was to describe outcomes following use of Fab2AV in patients with rattlesnake envenomation in Arizona.

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The Toxicology Investigators Consortium (ToxIC) Registry was established by the American College of Medical Toxicology in 2010. The registry collects data from participating sites with the agreement that all bedside and telehealth medical toxicology consultation will be entered. This eleventh annual report summarizes the Registry's 2020 data and activity with its additional 6668 cases.

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The Toxicology Investigators Consortium (ToxIC) Registry was established by the American College of Medical Toxicology (ACMT) in 2010. The Registry collects data from participating sites with the agreement that all bedside medical toxicology consultation will be entered. This tenth annual report summarizes the Registry's 2019 data and activity with its additional 7177 cases.

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Objective: To present two cases of delayed acetaminophen absorption in abdominal trauma patients with concomitant acetaminophen overdose.

Cases: Case 1. A 25-year-old female arrived to the emergency department with multiple stab wounds.

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Marine envenomations can cause a diverse array of clinical syndromes. Systemic and life-threatening reactions, as well as delayed presentations, can occur. The pediatric population is at higher risk for serious reactions to envenomations because their greater body surface area and smaller body mass can lead to a higher relative venom load.

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The Toxicology Investigators Consortium (ToxIC) Registry was established by the American College of Medical Toxicology (ACMT) in 2010. The Registry collects data from participating sites with the agreement that all bedside medical toxicology consultation will be entered. The objective of this ninth annual report is to summarize the Registry's 2018 data and activity with its additional 7043 cases.

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Background: Historically, anticoagulants and antiplatelet agents included warfarin and aspirin, respectively. In recent years, numerous novel anticoagulants (eg, direct thrombin inhibitors and factor Xa inhibitors) as well as the adenosine diphosphate receptor antagonists have increased significantly. Little information on the bleeding risk after exploratory ingestion of these agents is available.

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Background: Twitter-based chat groups (tweetchats) structured as virtual journal clubs have been demonstrated to provide value to learners. In order to promote topics in medical toxicology, we developed the #firesidetox tweetchat as a virtual journal club to discuss and disseminate topics in medical toxicology.

Methods: A group of medical toxicologists from the American College of Medical Toxicology (ACMT) Public Affairs Committee and editorial board of the Journal of Medical Toxicology (JMT) developed a quarterly one hour tweetchat featuring JMT manuscripts.

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Article Synopsis
  • This study compares two antivenom dosing strategies (maintenance vs. as-needed [PRN]) for treating rattlesnake bites in terms of patient outcomes.
  • It included 310 adults treated at a toxicology center, analyzing factors like demographics, antivenom use, and hospital stay length.
  • Results showed that PRN patients used significantly less antivenom and had a shorter hospital stay, with no differences in complications or follow-up issues.
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Background: Rattlesnake envenomation is an important problem in the United States, and the management of these envenomations can be complex. Despite these complexities, however, the majority of such cases are managed without the involvement of a medical toxicologist. The primary objective of this study was to evaluate the impact of a medical toxicology service (MTS) on the length of stay (LOS) of such patients.

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Study Objective: In recent years, the use of novel anticoagulants and antiplatelet agents has become widespread. Little is known about the toxicity and bleeding risk of these agents after acute overdose. The primary objective of this study is to evaluate the relative risk of all bleeding and major bleeding in patients with acute overdose of novel antiplatelet and anticoagulant medications.

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The American College of Medical Toxicology established the North American Snakebite Registry (NASBR), a national database of detailed, prospectively collected information regarding snake envenomation in the United States, in 2013. This report describes the epidemiology, clinical course, and management of snakebites in the NASBR. All cases entered into the NASBR between January 1, 2013 and December 31, 2015 were identified.

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