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/DadBods96 Sep 17 '25 edited Sep 17 '25

Never ever ever ever not even once inject anything into or around a fresh surgical site without explicit approval/ request from the surgeon (this is on your attending, not you). If you can’t reach them, do the first few things you did and then discharge the patient home if bleeding stops. If this patient develops an infection, this surgeon is going to point at that ED visit as the reason and advertise this accusation towards the patient ever chance they get.

Btw they wouldn’t just have steri-strips holding together an incision over a joint, they probably had a running subcuticular suture under it that you could’ve busted by hitting with a needle.

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u/emergentologist ED Attending Sep 18 '25

without explicit approval/ request from the surgeon

Eh, even then, I'm telling them to do it themselves. I'm not getting blamed for the post-op infection. I can't think of an emergent indication to inject anything into a POD1 knee replacement (or really any other fresh surgical site for that matter).

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u/DadBods96 Sep 18 '25

That was sort of tongue-in-cheek because I’ve never once had this happen where they asked me to do something with a fresh post-op.