Question

A $56$-year-old woman is brought to the emergency department by her husband due to rapidly progressive pain, swelling, and redness of her left lower leg over the past $24$ hours. She has a history of type 2 diabetes mellitus and peripheral neuropathy. She felt feverish earlier today and experienced a single episode of vomiting. On triage, her temperature is $39.2^{\circ}\mathrm{C}$ ($102.6^{\circ}\mathrm{F}$), blood pressure is $88/54\mathrm{\ mmHg}$, pulse is $122/\mathrm{min}$, and respirations are $24/\mathrm{min}$. Physical examination reveals an ill-appearing patient. The left lower extremity demonstrates diffuse, poorly demarcated erythema and tense edema extending from the ankle to the proximal calf. There are distinct violaceous bullae present on the anterior shin. Palpation of the leg elicits exquisite pain out of proportion to the visible skin changes, and faint crepitus is noted. Laboratory studies show a leukocyte count of $24,500/\mathrm{mm}^3$ with $18\%$ bandemia, a serum sodium level of $130\mathrm{\ mEq/L}$, and a serum creatinine of $2.1\mathrm{\ mg/dL}$. Which of the following are the most appropriate immediate steps in the management of this patient? (Select all that apply)