Spreading cellulitis / systemic infection — expanding erythema, purulence, odor, fever, or new confusion — notify for culture/antibiotics; sepsis signs → transfer.

Necrotizing infection — crepitus, dusky/black skin, pain out of proportion, rapid spread — emergency transfer.

Dehiscence with evisceration (surgical wound) — cover with sterile saline gauze, do not reduce, transfer.

Probe-to-bone over a bony prominence or exposed bone/tendon — osteomyelitis concern, notify provider.