Case Report: Soldier With Latrodectism After Black Widow Spider Bite During a Field Training Exercise.

Latrodectism from black widow spider (BWS) bites is rare in the United States. Latrodectism is a severe systemic manifestation of the envenomation that includes severe abdominal pain mimicking acute surgical abdomen and, in rare cases, could lead to acute myocarditis and rhabdomyolysis. The BWS typically inhabits dark, low-lying areas such as woodpiles, tree stumps, outdoor storage, outdoor furniture, outdoor toilets, and rock piles and is most active during warm weather months. Military service members often participate in field training exercises during warm weather in wooded areas littered with woodpiles and tree stumps; therefore, they are at an increased risk for bites by arachnids. We report the case of a 26-year-old active duty male soldier evacuated from field training with latrodectism and possible envenomation-induced myocarditis after a suspected BWS bite.

Immersive Virtual Reality for Pain Control and Anxiolysis During IV Blood Draws in Adults: A Randomized Controlled Trial.

OBJECTIVE: To evaluate immersive virtual reality's (IVR) effectiveness as a distraction in reducing perceived pain and anxiety among adults undergoing intravenous (IV) blood draw. METHODS: In this randomized controlled trial, we recruited adult patients 18-50 years of age scheduled for routine blood draws at the phlebotomy lab and randomized them into experimental and control groups. The experimental group underwent IV blood draw with IVR, and the control group underwent IV blood draw with standard practice. Before the procedure, subjects rated their anxiety level and the pain they "expected" to experience during blood draw. Immediately afterward, the subjects rated their actual "perceived" pain level. We measured the "expected" and the "perceived" pain and anxiety scores using a 100 mm visual analog scale. The primary outcome was the difference in "perceived" pain scores (0-100) between the two cohorts. Secondary outcomes were differences between the anxiety scores and the "expected" and "perceived" pain between the two cohorts, as well as degree of satisfaction with IVR during the blood draw and willingness to use IVR in future procedures. RESULTS: Fifty-nine subjects completed the study, 31 in the experimental group and 28 in the control group. For the primary outcome, the control group reported a perceived median pain score of 6.5 vs. the experimental group of 5; P = .55. For the secondary outcomes, the median anxiety scores were 22 (6.25-45.75) and 24 (2.00-35.00) for the control and the experimental groups, respectively, P = .44. The control group reported an expected median pain score of 20 vs. a perceived score of 6.5; P = .25, and the experimental group reported an expected median pain score of 22 vs. a perceived score of 5; P < .01. Median Likert scores were 5 (1-5) for satisfaction and preference for future use during painful procedures. CONCLUSIONS: The results of our study demonstrated that there was no significantly lower perceived pain or anxiety when using IVR compared to standard practice in adults undergoing IV blood draw.