The context of the original meme is chaos, as is represented through the fire in the background and the way that Elmo’s arms are flung up in the air. This iteration of that meme references getting hand sanitizer on a cut, and mainly, the burning sensation that hand sanitizer can make a cut or open wound feel as it disinfects it. Especially, a cut on your hand that you didn’t know was there and the stinging and surprising way that you find out about that cut upon putting on hand sanitizer.
This uses the burning fire background to refigure the implication from chaos and hell to the literal burning sensation that hand sanitizer has on an open wound like a cut. The rhetorical situation is used in a more literal sense to provide an exaggerated visual of the feeling of the hand sanitizer stinging, and it uses Elmo as an exaggerated representation of how you or the person with the cut feels upon getting blindsided by the stinging. The overly dramatic visual aspect of fire in the background is what I find to be the element that most contributed to the meme’s rhetorical velocity.
The immediate context needed to understand this iteration of the Elmo Rise meme is that hand sanitizer causes a burning sensation to cuts and open wounds as it disinfects them.
More immediate context to comprehend the complexities of this meme iteration is that the subject, Elmo, is the main character on an educational children's show Sesame Street that has been running for 55 years since 1969. Elmo is a nice, polite and childlike furry red character, so this stark contrast of him emerging with fire presents a more evil tone.
The rhetorical impact of this is that the very trivial and mundane task of applying hand sanitizer is very relatable, as is having a cut that goes unnoticed until the instant that it comes in contact with hand sanitizer.
The 'rise' reaction is intentionally and comically exaggerated, reflecting how heightened emotions would be in that instance of feeling stinging seemingly out of nowhere.
The original meme transformed from its original context to a more literal one to appeal to an audience that has physically experienced this and can find the humor in its accuracy.
Only the meme's caption was altered for this iteration, and the rhetorical situation that gave rise to this new meme is the background being engulfed in burning flaming, and Elmo appearing frantic with his arms flung up in a way that implies what experiencing that unexpected stinging pain is like.