A 17-year-old high school student presented with a history of habitual faintings. On 24-hour Holter monitoring, cardiac asystoles were recorded, the longest lasting approximately 7 or 8 seconds during venipuncture procedures. The asystole associated with venipuncture demonstrated the cardioinhibitory effects of vasovagal reaction with blood-injury phobia. He also had a positive response during head-up tilt test showing hypotension and relative bradycardia after intravenous isoproterenol injection. After administration of oral beta blocker, he did not show further or recurrent cardiac asystole during blood injury procedure on electrocardiographic examination. Venipuncture is the most common invasive medical procedure performed in hospital settings. While venipuncture is considered to be reasonably safe, serious complication may occur even when only a small volume of blood is withdrawn. Therefore, medical personnel should be prepared to provide appropriate care.
Adolescence ; Case Report ; Heart Arrest/etiology* ; Human ; Male ; Phlebotomy/psychology* ; Recurrence ; Syncope/etiology ; Vagus Nerve/physiology*

PURPOSE: This study aims to investigate two different distraction methods, distraction cards and kaleidoscope, on pain and anxiety relief of children during phlebotomy. METHODS: This study is a prospective, randomized and controlled trial. The sample consisted of 7-11 year-old children who required blood tests. Children were randomized into three groups: the distraction cards group, the kaleidoscope group, and the control group. Data were obtained by interviewing the children with their parents and the observer before and after the procedure. The pain levels of the children were assessed by the parent and observer reports as well as self report using the Wong Baker FACES Pain Rating Scale. The anxiety levels of children were assessed by parent and observer reports using Children Fear Scale. RESULTS: One hundred and eighty-eight children (mean age, 8.8 +/- 1.5 years) were included. The pain levels of children showed significant differences among the groups (p = .005). Both the distraction card group (2.41 +/- 2.49) and the kaleidoscope group (3.10 +/- 2.16) had lower pain levels than the control group did (4.44 +/- 3.64). The distraction card group had the lowest pain levels (2.41 +/- 2.49) among all groups. The procedural anxiety levels of children were significantly different among the groups (p = <.001). Both the distraction card group (1.10 +/- 1.20) and the kaleidoscope group (1.61 +/- 1.12) had lower anxiety levels than the control group did (2.41 +/- 1.30). The distraction card group had the lowest anxiety levels (p = <.001). CONCLUSION: The distraction cards were the most effective method for pain and anxiety relief of children during phlebotomy. Also the distraction method with kaleidoscope was an effective method for pain and anxiety relief during phlebotomy in children.
Anxiety/etiology/*prevention & control/psychology ; *Attention ; Child ; Female ; Humans ; Male ; Pain/etiology/*prevention & control/psychology ; Pain Management/instrumentation/*methods ; Parents/psychology ; Phlebotomy/*adverse effects/psychology ; Prospective Studies ; Questionnaires ; Treatment Outcome

Thirty-five year-old Amadeus Mozart died in Vienna after an acute illness that lasted only 15 days but no consensus has been reached on the cause of his death. From many letters written by his farther it is almost certain that he experienced at least three episodes of acute rheumatic fever attack in his childhood, and a relapse of rheumatic fever was suggested to have killed Mozart, although death from acute rheumatic fever is very rare in adults. His last illness was characterized by high fever, massive edema, vomiting and skin rash. His last illness can be explained by infectious endocarditis and heart failure. During his last hours, he was given phlebotomy, possibly for the third time in two weeks, and soon after he became unconscious and died. As such, phlebotomy performed on a man dehydrated by high fever and vomiting may have caused systemic shock. In summary, Mozart probably died from chronic rheumatic heart disease complicated by infective endocarditis and heart failure, and repeated phlebotomy-induced hypovolemic shock.
Adult ; Bloodletting ; Consensus ; Edema ; Endocarditis ; Exanthema ; Fever ; Heart Failure ; Humans ; Phlebotomy ; Recurrence ; Rheumatic Fever ; Rheumatic Heart Disease ; Shock ; Unconscious (Psychology) ; Vomiting

PURPOSE: To determine the effects of provision of information on mother's problem focused coping ability during their child's intravenous procedure. METHODS: Data were collected from 56 mothers whose children have admitted to pediatric ward in the hospital. The participants included 27 intervention group mothers and 29 control group mothers. For the information intervention, "Programmed Information for Parental Coping before Intravenous Procedure (PIPC-IP)", video program was made based on self-regulation theory for the experimental group mothers. Mother's coping ability was measured by parental supportive behavior, parental beliefs and Profile of Mood State (POMS). RESULTS: Mothers who received PIPC-IP showed significantly higher levels of supportive behavior (t = 3.55, p = .005) and Parental Beliefs (t = 2.95, p = .005), but no significant difference in negative mood on POMS (t = .15, p = .87) compared to mothers in the control group. CONCLUSIONS: These results demonstrate that PIPC-IP is an effective intervention to increase the supportive behaviors and beliefs of mothers' problem focused coping ability but not the negative mood.
*Adaptation, Psychological ; Adult ; Attitude to Health ; *Child, Hospitalized/psychology ; Child, Preschool ; Double-Blind Method ; Emotions ; Female ; Health Education/*organization & administration ; Humans ; Infant ; Korea ; Male ; Mother-Child Relations ; *Mothers/education/psychology ; Nursing Evaluation Research ; *Phlebotomy/adverse effects/psychology ; Problem Solving ; *Programmed Instruction as Topic ; Psychological Theory ; Questionnaires ; Social Support ; Videotape Recording