For severe mediastinal emphysema symptoms, what management is indicated?

• A. Hyperbaric full recompression
• B. Shallow recompression
• C. Immediate surgery
• D. Antibiotics

Answer: (B)

Mediastinal emphysema from diving is treated by hyperbaric oxygen therapy to shrink the gas bubbles and improve oxygen delivery to tissues. The pressure treatment helps compress the bubbles (Boyle’s law) and the high oxygen level speeds up outgassing and tissue oxygenation (Henry’s law).

Using shallow recompression starts this process promptly at a moderate pressure, which can rapidly reduce the bubble size and relieve symptoms. It’s a safer, faster way to begin treatment in a patient with significant but not yet unstable symptoms, with the plan to escalate to deeper recompression if needed based on response.

Antibiotics aren’t indicated unless there’s a specific infection; immediate surgery isn’t the standard for this condition unless a complication mandates it. Hyperbaric therapy at deeper pressures is reserved for cases that don’t respond to initial treatment or have more severe, life-threatening decompression symptoms.