Upper respiratory tract infections Quiz: Ace Your Exams

A 30-year-old man presents to the emergency department for evaluation of fever, painful swallowing, and difficulty breathing. Two weeks ago, he swallowed a fishbone and since then, has been experiencing a scratching sensation in his throat which seemed to be resolving. Five days ago, he began having pain with swallowing which has been getting progressively worse. Over the past 24 hours, he has experienced worsening pain, fever, and excessive drooling. Medical history is significant for pre-diabetes. Temperature is 38.9°C (102.0°F), pulse is 114/minute, respiratory rate is 28/minute, blood pressure is 102/72 mmHg, and oxygen saturation is 88% on room air. On physical examination, the patient appears acutely ill and in respiratory distress. He is taking shallow breaths and is using accessory muscles of respiration. He is drooling and has difficulty opening his mouth completely, making it challenging to perform a complete oropharyngeal examination. He has tender cervical adenopathy, neck swelling, and inspiratory stridor. Cardiac examination is unremarkable and there are no wheezes or crackles on pulmonary examination. Which of the following is the best next step in management?