Necrotizing Soft Tissue Infections (NSTIs) are rare, with an annual incidence of 0.04/1000 in the US. Typical precipitating events: breaks  in epithelial or mucosal surfaces. Early findings: erythema (80%), induration (66%), tenderness (54%) . Late findings include pain out-of-proportion, skin bullae, and unstable vitals. Key characteristics are signs/symptoms progress within hours, much faster than abscess or cellulitis. The gold standard for diagnosis is operative exploration.  Mortality rates decrease from 28% to 4.5% with surgical debridement within 12 hours of ED admission.