Aspiration pneumonia and pneumonitis Quiz: Ace Your Exams

A 75-year-old man is brought to the emergency department for evaluation of cough and shortness of breath. The patient’s spouse is at the bedside and reports that the patient currently resides in a nursing facility due to advanced multiple sclerosis. The patient has had increased difficulty swallowing over the past week. Temperature is 39.0°C (102.2°F), pulse is 114/min, blood pressure is 148/91 mmHg, and oxygen saturation is 95% on room air. Physical examination is significant for a chronically ill-appearing male with contractures in the bilateral upper and lower extremities. The patient is coughing but has no significant increased work of breathing. Blood work is obtained and is pending, and chest radiograph is shown below. Which of the following is the best next step in management?
 
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