A 28-year-old man from Mumbai presents with acute onset of bilateral ptosis, ophthalmoplegia, and respiratory difficulty 2 hours after receiving an aminoglycoside antibiotic for a urinary tract infection. He has a known history of myasthenia gravis on pyridostigmine monotherapy. Bedside spirometry shows FVC 1.2 L (predicted 4.5 L). What is the most appropriate immediate next step?

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