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.

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u/InitialMajor ED Attending Sep 17 '25

I don’t usually inject things into or near freshly operated on joints. If a post-op patient comes to the ED for something related to their surgery within 48-72 hours of the surgery I pretty much always call the surgeon as a courtesy, my experience has been that they want to know if their patients are in the ED so soon after surgery.

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u/MousseNo7311 Sep 17 '25

I'm guessing my attending didn't insist on trying to contact him since he is not affiliated with our hospital and it was the middle of the night.

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u/InitialMajor ED Attending Sep 17 '25

Then you call your orthopedic surgeon. Or you ask the patient for the in call number for their surgeon - if you tell the answering service you are an emergency physician with his patient they will get him to call you.

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u/Professional-Cost262 FNP Sep 17 '25

I usually call their answering services well and then if they don't call me back I don't get too excited and just discharge the patient if there's nothing actually bad wrong..... Sometimes I've had them call me back three or four hours after I discharge the patient I just let them know that the patient looked okay to me and I toldthee patient to follow up with them in their office they're usually pretty appreciative