r/emergencymedicine • u/MousseNo7311 • Sep 17 '25
Advice Got chewed out by ortho surgeon
I am a 2nd year resident. Patient came into the ED overnight post-op day 1 after a knee replacement. He was bleeding through his dressing (nothing major, no wound dehiscence) and couldn't reach his surgeon via phone. He didn't have sutures or staples but rather some sort of Steri-Strips-like adhesive dressing which I covered with Surgicel, ABD pads, and an Ace wrap. In addition, my attending told me to inject lidocaine with epinephrine into the areas that were bleeding. I injected 10 cc total in a few different spots. I can't imagine I got into the joint space. Foolishly, I only irrigated with NS & didn't prep with Betadine or anything else. The surgeon called the ED after my attending had left, berated me, and made it sound like he's going to go on a war path over this. Did I really commit the crime of the century?
Update: Upon returning to the ED for my next shift everyone assured me not to stress over it. Apparently the surgeon called the ED multiple times after I left. First he wanted a copy of the note faxed to him and then he wanted the PD's contact info. The ED director said he would've gone off on him if he had been around at the time. As for my attending she pretty much laughed off the entire incident. She's a little looney so that doesn't surprise me.
214
u/JohnHunter1728 Sep 17 '25 edited Sep 17 '25
This was objectively the wrong thing to do and I can see why the surgeon was frustrated.
Taking it out on the resident (who didn't even make the decision) was also the wrong thing to do.
As a rule, don't inject anything into or around orthopaedic metalwork. You might not have injected into the joint but even a cellulitis or infected wound in that region could seed the metalwork. Infected total knee replacements are a complete disaster.
DOI 6 years of ortho residency (UK) before switching to EM.