Objective: To describe the epidemiology of emergency cases of suspected acute carbon monoxide poisoning related to water pipe (shisha) smoking responded to by emergency medical services (EMS).

Methods: This study included emergency calls for patients who smoked a water pipe or were working in water pipe cafes between January 2018 and June 2023 in the southwestern area of Tokyo. Case characteristics, including carboxyhemoglobin (COHb) levels of patients treated at a tertiary emergency medical facility, were obtained from EMS and hospital records.

Results: A total of 64 cases were included. Patients were mostly in their 20s with loss of consciousness or vomiting. Symptoms occasionally developed in patients who smoked for less than 30 minutes. Most patients were classified as mild cases. Two patients were classified as severe cases. The mean COHb level of the three patients treated at a tertiary emergency medical facility was 18.5%.

Conclusions: We encounter emergency cases of suspected acute carbon monoxide poisoning related to water pipe smoking once a month. Emergency medical personnel should be aware of the risk of overlooking carbon monoxide poisoning and should respond to water pipe related emergency calls with suspicion of acute carbon monoxide poisoning.

Purpose: This study aimed to clarify the learning needs of proficient and experienced nurses in the emergency and intensive care fields relating to nursing patients with severe trauma.

Methods: We conducted semi-structured interviews with 10 proficient and nine experienced emergency and intensive care nurses. Online interviews were conducted about required learning for nursing patients with severe trauma. A qualitative descriptive research method was used for analysis.

Results: We generated the following categories regarding learning needs for nursing of patients with severe trauma: for proficient nurses, seven categories including [accurate understanding of initial treatment guidelines for trauma that form the basis of trauma nursing]; and for experienced nurses, seven categories including [discussing case studies to share experiences and improve trauma nursing care].

Conclusion: The learning required by proficient and experienced nurses for nursing patients with severe trauma shared features such as acquiring relevant medical knowledge and case studies. However, differences existed in needs due to nurse experience and qualifications. This finding suggests that trauma nursing education should be based on experience.

In this report, we present the implementation of our multidisciplinary approach for the management of emergency maternal caesarean sections in pregnant women with severe coronavirus disease-2019 (COVID-19).

Case 1: Emergency caesarean section was conducted due to sudden-onset respiratory failure to save both the mother and foetus. As preparing the COVID-19-specific operating theatre would have required several hours, the patient was immediately intubated and stabilized in the isolation ward. At 209 min following intubation, the infant was delivered by emergency caesarean section. Although both the mother and infant were saved, the infant could not leave the operating theatre because it had “sleeping baby syndrome” caused by the prolonged sedation of the mother. This necessitated continuing the procedure under high temperature and high humidity conditions. Based on the lessons learned from this experience, a standardised protocol to promptly prepare and perform an emergency caesarean section for pregnant women in isolation due to COVID-19 was established.

Case 2: A pregnant woman was isolated due to COVID-19, her respiratory function deteriorated significantly and an emergency caesarean section was performed. To avoid sleeping baby syndrome in the foetus, an urgent preparation and procedure were performed, and the infant was delivered within 1 min 42 sec following intubation of the mother. The infant could leave the operating theatre immediately and the rest of the operation was performed at normal room temperature and humidity. To perform emergency caesarean section in pregnant women with COVID-19 involving multidisciplinary teams, preoperative training and preparation are required - as well as active and candid proposals and discussions among the personnel concerning all obstetrics-specific issues. The challenges experienced in the two reported cases can inform the development of protocols for emergency caesarean section and maternal resuscitation for future emerging infectious diseases requiring isolation.

We experienced two cases of Cattle-related facial trauma that required emergency tracheal intubation.

Case 1: A 77-year-old man was headbutted to his face by cattle and called for emergency medical assistance. Initially, the patient could speak, admitted without intubation but later experienced an airway emergency. Oral intubation was challenging, necessitating cricothyrotomy puncture for airway maintenance. On the second day, another attempt at oral intubation was challenging but ultimately successful with the use of McGRATH ^TM. Tracheostomy was performed on the 7th day, and the patient left the intensive care unit on the 14th day without evidence of hypoxic encephalopathy.

Case 2: An 80-year-old woman suffered a cattle-related facial injury and was transferred to our hospital. A computed tomography scan revealed mandibular and nasal bone fractures, along with middle pharyngeal compression due to pharyngeal hematoma. Intubation was difficult; therefore, we performed the procedure using a Gum Elastic Bougie. Tracheostomy was performed on the 8th day, and the patient left the intensive care unit on the 15th day.

Cattle-related facial trauma can result in panfacial fractures and may potentially need difficult airway management (DAM).