Street medic assessment/plan (I understand some of this has already been answered):
Airway/ENT: Patency, secretions?
Breathing/respiratory: Rate, depth, quality, breath sounds?
Circulation/cardiac: BP, quality of peripheral and central pulses, cap refill, cardiac sounds?
Neuro: AVPU, NIHSS?
GI: Onset of nausea, appearance of emesis any any bowel movements, abdominal sounds, palpation, percussion (typanic vs dull), liver edge, intake since discharge?
GU: Color/quality/quantity of urine that has been produced, CVA tenderness?
Skin/Lymph: Skin quality, brusing, any other visual abnormality, any palpable lymph nodes?
MS: general strength, tone?
Consitutional/endocrine: Fever history, chills, appetite?
Allergies, medical history, surgical history, travel in the past 3 weeks, daily medications (including those that were held or she has not taken), OTC/Rx'd meds since discharge, supplements, implants, anesthesia history (including any family history of anesthesia reactions), vaccination history?
BGL, EKG, capnography, vitals.
DDX:
I think that this patient is more likely to have an uncommon complication given the previous responses. With what seems to be a benign GI palpation/exam I doubt she has a perforation or infection. Therefore without a good infection source I doubt the patient is septic, I think that the fever may be from being somewhat poikilothermic older person or more likely from a more serious etiology; I would consider flu or other viral infection but she doesn't seem to fit with that disease profile.
I think that this patient is either having an atypical MH presentation or another cause of acute renal failure (be it from NSAIDs, other nephrotoxic medications, hypotension during the procedure, or whatever else).
Treatment: two large bore IVs, aggressive IV fluid management, consider antiemetics favoring those with less proclivity towards zofran due to the already present profound dehydration (in fact in this patient I would favor giving a small dose of ativan), foley if I suspect bladder distension, rapid transport to a center that stocks dantrolene and has CRRT capability.
Hospital course:
Patient needs to be rapidly assessed and differentiated for MH, sepsis/infection, and acute renal failure. CBC, CMP, gas/lactate, CRP, Procal, blood cultures, troponin UA/culture, respiratory viral panel, serial EKGs. Imaging is necessary but we need to consider that if we give contrast that we will probably damage her kidneys. Portable CXR and KUB, POC ultrasound (specifically looking at the kidneys, liver, and bladder), consider MR/CT based on initial labs and bedside imaging.
Admission and further treatment based on ED course, will probably need a CHCT at some point.
