12. Red flags and emergency escalation
Any of the following is acted on immediately. EMS is activated first for life threats; provider notification and orders follow.
Red flags — act immediately Wound dehiscence with evisceration → cover with sterile saline-moistened gauze, keep the patient supine with knees flexed, and activate EMS. Necrotizing infection signs — pain out of proportion, crepitus, dusky or necrotic skin, rapid spread, systemic toxicity → activate EMS; this is a surgical emergency. Spreading cellulitis, streaking, fever, or new confusion from a wound source → notify provider urgently; possible culture and antibiotics; consider sepsis. Exposed bone or a positive probe-to-bone in a non-healing wound → osteomyelitis concern; notify for urgent evaluation and imaging. New deep-tissue injury or a newly unstageable wound → notify; revise the offloading and treatment plan. Bleeding wound on an anticoagulant not controlled with pressure → hold pressure, activate EMS if not controlled, and review with the Anticoagulation overlay. |
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