A 23-month-old child presents with severe pharyngitis and drooling. What is the most appropriate next step?

In a case involving a 23-month-old child presenting with severe pharyngitis and drooling, the condition raises concerns regarding potential airway obstruction, which may be linked to severe infections like epiglottitis or croup. The presence of drooling is particularly alarming as it often indicates that the child is having difficulty swallowing, which can be a sign of respiratory distress or impending airway compromise.

Transferring the child emergently is the most appropriate next step because it ensures that they receive immediate, specialized care in an environment equipped for airway management. The current clinical presentation demands urgent evaluation and possibly intervention to secure the airway, and transferring to a facility with pediatric capabilities can provide access to resources such as intubation equipment, hospital specialists, and critical care.

Other interventions, such as administering antibiotics like ceftriaxone or treatments like racemic epinephrine, may be indicated for infections and swelling respectively, but those actions could delay critical airway management. Obtaining intravenous access is important for treatment, but in the context of severe pharyngitis combined with drooling, ensuring that the child's airway is stable takes priority.