A 68-year-old man with myasthenia gravis presents to the emergency department with acute respiratory distress, ptosis, and generalized muscle weakness. He has been on pyridostigmine 60 mg QID for the past 2 years. His wife reports he ran out of medication 3 days ago. On examination, he has severe bulbar weakness and vital capacity of 1.2 L. What is the most appropriate immediate next step in management?

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