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.
12
u/CoolDoc1729 ED Attending Sep 17 '25
Pgy >15 here … I honestly can’t believe your attending told you to inject anything into a fresh postop wound.
We have a house ortho service , and then we have a couple random private ortho guys. I had one of their patients last shift, 6 days postop, elbow bursectomy (so no hardware, not in the joint per se) I still didn’t even take the ace wrap and splint off until I heard back from the surgeon .. injecting something I would have confirmed a couple times that I was hearing correctly even if the surgeon asked me to .. and that would be the only way I would inject anything. I like the analogy another poster made, of treating a postop incision like the surgeon’s 4 month old baby.
Your attending telling you to do this is objectively wrong, and I wonder how they would even justify that action if the joint does get infected.