A 48-year-old man from Mumbai with known generalized myasthenia gravis (seropositive for AChR antibodies) on pyridostigmine 60 mg four times daily presents with acute worsening of muscle weakness, respiratory distress, and increased salivation. His wife reports he took an extra dose of pyridostigmine 2 hours ago after feeling weak. Vital signs: BP 110/70 mmHg, HR 88/min, RR 24/min. Which of the following is the most appropriate next step?

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