Soru

A 65-year-old man with a history of type 2 diabetes mellitus and peripheral neuropathy is brought to the emergency department due to rapidly worsening right leg pain, swelling, and fever over the past 12 hours. The patient reports the pain is excruciating and much worse than the visible skin changes would suggest. He is confused and lethargic. Vital signs are temperature $39.4^\circ\text{C}$ ($102.9^\circ\text{F}$), blood pressure $82/50\text{ mmHg}$, heart rate $128/\text{min}$, and respiratory rate $24/\text{min}$. Physical examination reveals a swollen, tense right lower extremity with poorly demarcated erythema advancing proximally toward the knee. Several violaceous bullae are present on the calf, and palpable crepitus is noted over the anterior tibia. Laboratory results show a leukocyte count of $24,000/\text{mm}^3$, serum sodium of $130\text{ mEq/L}$, and serum creatinine of $1.9\text{ mg/dL}$. Vigorous intravenous fluid resuscitation is initiated. Which of the following is the most appropriate next step in management?