LewisGale Hospital Montgomery

Context: Abdominal fascial plane blocks have proven effective and vital for multimodal opioid-sparing postoperative analgesia in multiple surgeries. Aims: The present study compared the postoperative analgesic efficacy of ultrasound-guided bilateral erector spinae plane block (UBESPB) to intrathecal fentanyl (ITF) after lower-segment cesarean section (LSCS). Settings and Design: This prospective, randomized controlled trial was conducted at a tertiary care teaching hospital between May 2021 and September 2022. Methods: A total of 60 term parturients of American Society of Anesthesiologists physical status II with singleton pregnancy planned for elective LSCS were randomized into two groups. Group 1 (UBESPB group, N = 30) were given spinal anesthesia with 1.5 ml heavy bupivacaine (0.5%), followed by UBESPB at the T9 level with levobupivacaine (0.25%) 30 ml, at the end of surgery. Group 2 (ITF group, N = 30) were given spinal anesthesia with 1.5 ml heavy bupivacaine (0.5%) added with 25 μg fentanyl. The static and dynamic pain (assessed by numerical rating scale [NRS]), total fentanyl consumption, residual motor blockade, time to ambulate and breastfeed, patient satisfaction rate, and opioid-related complications were evaluated for up to 48 h postoperatively. Statistical Analysis: Statistical analysis was performed using the Chi-square test to compare categorical variables and the independent sample t-test to compare continuous variables. A P value of <0.05 was considered significant. All analyses were carried out using SPSS version 16.0 (Chicago, USA). Results: In the UBESPB group, the mean static and dynamic NRS pain scores and the mean total fentanyl consumption were significantly lower (170.73 ± 37.71 μg) as compared to the ITF group (642.03 ± 177.49 μg). No additional increase in the residual motor blockade was seen in either group. Most of the patients in the UBESPB group were highly satisfied and able to ambulate and breastfeed early, as compared to the ITF group. Conclusion: UBESPB proved to be significantly more efficacious in terms of pain relief (static/dynamic), patients’ satisfaction, and early ambulation and breastfeeding with better newborn care as compared to ITF.

At the heart of our commitment to the care and improvement of human life are the physicians who dedicate themselves to delivering exceptional care. To support not only our physicians’ professional excellence but also to foster personal fulfillment, HCA Healthcare partnered with Claremont Graduate University to establish the Physician Wellness Research Lab (PWR Lab). In his new role as the Vice President of Academic Affairs for Graduate Medical Education (GME), Dr Guldner led a nationwide search to establish and implement a new approach to well-being. At HCA Healthcare, we believe that true flourishing requires transforming the work and learning environment itself. To guide our approach, we identified 2 complementary theories: Job Demands-Resources (JD-R) Theory and Self-Determination Theory (SDT), which steer the transformation of environments from need-thwarting to need-supporting. Studies conducted in partnership with the PWR Lab confirmed the necessity of a research-driven approach in establishing healthy environments. This work has culminated in the creation of the Resident Experience and Retention Summit (RERS). This teaching workshop is designed for faculty and administrators committed to advancing provider well-being through improvements in the work and learning environment. Participants explore the practical application of SDT and JD-R Theory, following either a clinical or administrative track tailored to their role. Since its launch in 2023, we’ve hosted 6 RERS and have seen meaningful changes in the perception of the work and learning environment across numerous facilities. This internal success in creating supportive environments is mirrored and validated by external, national metrics. For the last 2 years, HCA Healthcare has beaten the national average in each of the 12 well-being items from the Accreditation Council for Graduate Medical Education (ACGME) Survey. At our most recent RERS teaching workshop we showcased poster submissions from both clinical and administrative colleagues highlighting the facility-level initiatives they’ve implemented. We are pleased to share the 8 abstracts featured, each showcasing the practical application of HCA Healthcare’s approach to well-being in diverse health care settings.

Patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD; historically termed non-alcoholic fatty liver disease [NAFLD]) are at increased risk of advanced fibrosis. Conventional antidiabetic therapies vary in their hepatic effects and, aside from pioglitazone, provide limited direct hepatic benefit. This systematic review evaluates the efficacy of empagliflozin 10 mg, the guideline-recommended starting dose, on hepatic and metabolic outcomes in this population. We systematically searched PubMed, Scopus, Web of Science, Embase, and Cochrane Central through October 10, 2025, for randomized controlled trials (RCTs) comparing empagliflozin 10 mg versus control (placebo or active comparators). Outcomes included liver fat content, liver stiffness measurement (LSM), controlled attenuation parameter (CAP), liver enzymes, and metabolic parameters. Pooled analyses were performed using mean differences (MDs) with 95

BACKGROUND Cardiopulmonary resuscitation-induced consciousness (CPRIC) is a rare phenomenon in which patients in cardiac arrest demonstrate signs of consciousness while undergoing cardiopulmonary resuscitation (CPR). Only a few cases of this phenomenon are reported in the literature. Previous studies estimate that CPRIC occurs in 0.23-0.9% of all cardiac arrests, with prevalence increasing over recent years. It has been proposed that the etiology of this phenomenon is the result of preserved cerebral perfusion during high-quality CPR. CASE REPORT A 52-year-old woman presented with witnessed out-of-hospital cardiac arrest after a bout of chest pain. During CPR, resuscitation was stopped multiple times due to signs of consciousness despite the patient being in ventricular fibrillation. Throughout the resuscitation attempt, the patient grunted, yelled, demonstrated purposeful movements, and opened her eyes. These actions resulted in considerable pauses in chest compressions, delays in routine advanced cardiac life support interventions, and psychological distress to the emergency medical services clinicians. After multiple defibrillations, the patient was successfully resuscitated and became oriented enough to answer questions and hold meaningful discussion. She was transported directly to the cardiac catheterization lab, where she underwent percutaneous coronary intervention to correct a 100% occlusive in-stent thrombosis of the mid-left anterior descending artery. CONCLUSIONS This case describes challenges health care professionals might face when CPRIC occurs. While sedation was considered, widespread protocols for sedation in CPRIC patients do not exist. More research is needed to determine the prevalence of CPRIC in the United States, as well as best practices for management of this rare phenomenon, for the safety of both patient and health care professionals.

Disclosure: E.J. Louwagie: None. J.N. Diego: None. C.S. Farooqi: None. M.M. Kamal: None. As prescriptions for sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and the novel agent tirzepatide continue to increase, a rare yet serious condition has emerged: euglycemic ketoacidosis (EKA). EKA is a life-threatening condition similar to diabetic ketoacidosis, except diagnosis is more challenging because patients present with normal to slightly elevated blood glucose levels. Tirzepatide is a novel dual agonist at GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors and is approved for treatment of diabetes and weight loss. Here, we describe a unique case in which a young male patient placed on both an SGLT2 inhibitor and tirzepatide developed EKA. The patient’s diagnosis was delayed, and he required treatment and monitoring in an intensive care unit. Clinicians should be aware of this rare yet potentially fatal complication as well as potential risk factors. Presentation: Monday, July 14, 2025