In the last fifteen years, hospitalists have become much more prevalent in the care of inpatients, and a hospitalist must be familiar with several skills and procedures. Often, new hospitalists have a background in outpatient practices and may not be as comfortable performing procedures. This course is an excellent refresher for experienced physicians, residents, and other healthcare providers. In a group setting, individuals will learn about the techniques of various procedures, including using ultrasound. In addition to the hands-on practice and lectures, the participants will be given examples of tools and order sets, and key articles will be provided for reference.
The following procedures will be taught using a combination of lecture, video, and hands-on practice with manikins and models. The participants will also get ample time to practice with an ultrasound on models and each other. Discussion and use of the ultrasound in the procedures is designated with an asterisk (*). Models and ultrasounds will be available for practice throughout both days of the course.
By the end of this activity, the participant should be better able to:
- Discuss indications, contraindications, and techniques of procedures commonly performed by hospitalists.
- Gain experience with the use of an ultrasound machine in hospitalist procedures.
- Learn pre-procedure evaluation and post-procedure management, including the Joint Commission mandates for Universal Protocol.
- Discuss prevention and management of complications of hospitalist procedures.
2025 Course Accreditation
The Texas Academy of Family Physicians designates this live activity for a maximum of 16.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The AAFP has reviewed Hospitalist Procedures and deemed it acceptable for AAFP credit. This session is approved for 16.00 AAFP Prescribed credits. Term of approval is from 07/17/2025 to 12/07/2025. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Learn more about our accreditation.
7:30 - 8 a.m.
- Registration and breakfast
Day One
8 – 10 a.m. — 2 CME Credits
Universal Protocols and Sedation for Procedures
- Review universal protocols and document informed consent, including risks, benefits, and alternatives.
- Discuss how appropriate communication between patients and health care teams is key to reducing medical errors.
- Identify when a situation requires emergency consent for immediate diagnosis and unforeseeable medical conditions that could lead to disability or death.
- Utilize approach sedation and anesthesia based on a patient’s condition.
- Recognize caution with sedation methods for patients with sleep apnea, lung disease, alcohol use, or a difficult airway.
Introduction to Ultrasound/FAST/eFAST
- Utilize ultrasound to assist in initial trauma assessment and to assist with various hospitalist procedures.
Vascular Access – Central Line With and Without Ultrasound / Intraosseous Line Placement
- Discuss the use of central line placement for central venous access.
- Learn to use ultrasound for line placement.
- Appropriately prevent complications and use central line placement when IV access or prolonged vasopressors are difficult.
- Discuss using intraosseous line placement for rapid access and emergency fluid induction.
- Learn appropriate placement of intraosseous lines in the femur, head of humorous, and tibia.
Arterial Line Placement
- Discuss the indications for arterial line placement, including respiratory failure, frequent arterial blood gas, and management of shock states.
- Discuss precautions for arterial line placement and the use of emergent placement when the patient is emergent, has peripheral vascular disease, or has coagulopathy.
- Discuss complications of arterial line placement, including AV fistula, pseudoaneurysm, bleeding, hematoma, infection, pain, or arterial thrombosis.
10 – 10:15 a.m. — Break
10:15 a.m. – 11:15 a.m. — 1 CME Credit
Lumbar Puncture
- Recognize when to order a lumbar puncture in patients.
- Discuss when to use CT or ultrasound for lumbar puncture procedure.
- Discuss various side effects and complications of a lumbar puncture procedure.
Paracentesis
- Utilize paracentesis for work-up of new onsite ascites, suspected spontaneous bacterial peritonitis, and work-up of malignancy.
- Discuss how to perform a paracentesis procedure and review possible complications.
11:15 a.m. – 12:00 p.m. — 0.75 CME Credits
Skills Lab Demonstrations
- Practice skills for central line, arterial line, lumbar puncture, paracentesis, and EZ intraosseous access placement.
12 – 1 p.m. — Lunch
1 – 3 p.m. — 2 CME Credits
Skills Lab, Continued
- Practice hands-on skills for the following hospitalist procedures: Central line placement, arterial line placement, lumbar puncture, paracentesis, and EZ/IO.
3 – 3:15 p.m. — Break
3:15 – 5:30 p.m. — 2.25 CME Credits
Hemodynamics, Shock States, Sepsis Protocol
- Discuss protocols for hemodynamics and appropriate identification of shock states and sepsis.
- Consider oxygen consumption, anaerobic metabolism, lactate accumulation, organ dysfunction, and the possibility of death.
- Review the symptoms of shock and the causes and types of shock.
- Review the symptoms of sepsis and evaluate early resuscitation, cardiovascular issues, what to administer to the patient and why, perform early cultures, administer early antibiotics, and avoid lung damage.
Ultrasound Demonstration Practice on Models and Other Participants, Skills Lab, Continued
- Continue hands-on practice of hospitalist procedures.
Day Two
8 – 10 a.m. — 2 CME Credits
Basic Airway Management / Advanced Airway Management, Intubations, and Adjunct Airways
- Review airway anatomy.
- Learn protocols for basic airway management, oral and nasal airways, bag valve mask ventilation, and basic intubation techniques.
- Review airway management pitfalls, including facial hair, poor dentition, and large neck anatomy.
- Review the indications and contraindications of how to choose the appropriate airway access.
- Discuss post-intubation management.
Surgical Airways / Needle Cricothyroidotomy
- Assess patients’ anatomy appropriately, including locating the back of the mouth, obstructions, bleeding, and other secretions.
- Adequately grade the airway to decide on an appropriate airway management method.
- Discuss the use of video laryngoscopy and fiberoptic intubation.
- Discuss the use of Combi Tube, King Airway, and needle cricothyrotomy.
10 – 10:15 a.m. — Break
10:15 a.m. – 12 p.m. — 1.75 CME Credits
Skills Lab
- Practice hands-on skills for the following hospitalist procedures: basic airway, intubations, LMA, laryngoscopy, intubation bougie, bag-valve mask ventilation, and lighted stylet intubation.
12 – 1 p.m. — Lunch
1 – 3 p.m. — 2 CME Credits
Thoracentesis
- Discuss indications for thoracentesis, including diagnostic evaluation of pleural effusion or therapeutic treatment of large symptomatic pleural effusion.
- Discuss the contraindications of thoracentesis, including small effusion, severe coagulopathy, or chest wall infection at the insertion site.
- Use thoracentesis for differential diagnosis, including mucus plugging, bronchial obstruction, pneumonia, or atelectasis.
- Discuss various complications of thoracentesis, including pneumothorax, hemothorax, diaphragm or other organ injury, sheared off catheter, and re-expansion pulmonary edema.
- Appropriately order study of fluids removed.
Thoracostomy Tube Placement / Thoracic Vent Placement
- Review the use of thoracostomy tube placement to open chest drainage adequately.
- Discuss the contraindications of thoracostomy tube placement and usage for emergent patients, bleeding diathesis, and loculations or pleural adhesions.
- Discuss indications for thoracostomy, including complication pleural effusion, empyema, pneumothorax, chylothorax, hemothorax, or pleurodesis.
- Utilize ultrasound for pneumothorax diagnosis, including tension, persistent pneumothorax, emphysema, or a blocked tube.
- Discuss when to remove chest tubes.
3 – 3:15 p.m. – Break
3:15 - 5:30 p.m. — 2.25 CME Credits
Noninvasive Ventilator Management, including CPAP, BiPAP, and High Nasal Flow Oxygen Therapy
- Discuss noninvasive ventilator management, including nasal cannula, simple mask, venturi mask, non-rebreather mask, high flow humidified nasal oxygen, non-invasive positive pressure ventilation, continuous positive airway pressure, bi-level post pressure ventilation, and non-invasive ventilation.
- Discuss contraindications of use of noninvasive ventilator management, including shock, unconsciousness, severe respiratory failure, excessive secretions, vomiting, GI bleed, or upper airway obstruction.
Basic Ventilator management, including ventilator settings and lung protective strategy
- Discuss the indications for ventilation, including respiratory failure, paralysis, general anesthesia, or airway protection.
- Discuss how ventilation can assist in the control of volume or pressure.
- Discuss complications of ventilation, including decreased lung compliance or increased airway resistance.
- Discuss how to prevent ventilator-associated pneumonia.
- Review sedation protocols for ventilator management.
- Discuss when patients can be removed from ventilation using a spontaneous breathing trial (SBT).
Skills Lab, continued from morning session.
- Practice hands-on skills for the following hospitalist procedures, including airway management, intubation, thoracostomy tube placement, pneumothorax, thoracentesis, ventilator management, and noninvasive ventilation.
- Practice hospitalist procedures using ultrasound techniques.
TOTAL CME CREDITS: 16
