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A 34-year-old man arrives in the ED with central cyanosis that began one hour after dental extraction of a molar. He received topical and infiltrated lidocaine during the procedure. On assessment, he is alert, able to speak normally, but has dusky lips. His oxygen saturation is 88% on room air, and this does not improve despite receiving high-flow oxygen.
Observations: HR 102 bpm, RR 20, BP 122/78 mmHg, Temp 37.1°C, SpO₂ 88% on 15 L O₂.
ABG: pH 7.42, PaO₂ 14.5 kPa.
What is the most appropriate next step in management?

Initiate non-invasive ventilation

Administer IV hydrocortisone

Observe without specific treatment

Order a CT pulmonary angiogram

Give IV methylene blue 1 mg/kg

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