A 42-year-old female presents to the emergency department with severe chest pain and dyspnea following forceful retching. She is hypotensive (BP: 85/55 mmHg), tachycardic (HR: 120 bpm), and febrile. Physical examination reveals subcutaneous crepitus over the chest and neck. A CT scan shows mediastinal air and fluid collection consistent with esophageal rupture. What is the most appropriate initial management for this patient?
