Figure 1 CT of chest on Day 1: patchy and clouded high-density shadows were observed in both lungs with unclear boundaries. Gas shadows can be seen in bilateral chest wall, subcutaneous soft tissue in axilla and mediastinum.
Given the hyperbaric oxygen treatment guidelines for emergency carbon monoxide poisoning, the patient was put into a hyperbaric oxygen chamber for emergency oxygen therapy in the hope of relieving lung inflammation and repairing nerve damage as much as possible, and began to take methylprednisolone, cefoperazone, citiciline sodium, omeprazole and other drugs, inhaled budesonide suspension and ambroxol hydrochloride solution for phlegm treatment, and injected compound brain peptide glycoside and niacinamide to promote nerve repair. No invasive ventilation was used. For the first hyperbaric oxygen treatment, the pressure was set to 1.3ATA(1ATA=760mmhg(101.32Kpa)) for 100 minutes using compressed air pressurization. The lethargy of the patient improved on the second day, and CT revealed that the double pneumonia and pneumomediastinum had been reduced compared with the previous day. After that, he continued to receive hyperbaric oxygen therapy at 1.3 ATA for one week. No other treatment options were changed, and after one week his CT showed that the lung inflammation and pneumomediastinum had completely subsided. After CT showed complete resolution of lung symptoms, he received consolidation oxygen at 1.6ATA for 5 days, during which time he did not develop symptoms of physical discomfort. Through follow-up, we learned that he had no symptoms of delayed encephalopathy or other complications. We will continue to follow up.