A 32-year-old farmer from Punjab is brought to the emergency department 45 minutes after accidental exposure to an organophosphate pesticide. He presents with pinpoint pupils, profuse salivation, bronchospasm, muscle fasciculations, and a heart rate of 48 bpm. Arterial blood gas shows pH 7.28, PaCO₂ 58 mmHg, and HCO₃⁻ 22 mEq/L. What is the most appropriate immediate next step in management?

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