Improving airway safety in the University Teaching Hospital, Lusaka, Zambia: a quality-improvement project

Abstract

The mean age was 28 yr. The majority of patients, 64/69 (93%), were male. By mechanism of injury, 55 (80%) were assaulted, there were five sports injuries (7%), four road traffic accidents (6%), four trips/falls (6%), and one case where the mechanism was unclear. Fifty-seven patients (83%) suffered isolated injuries; 12 (17%) sustained concomitant injuries, although none required any other operative intervention. No patients suffered a C-spine injury. The most widely used 'primary' laryngoscopy strategy, in 43 cases (62%), was video laryngoscope (C-MAC®, Karl Storz GmbH & Co. KG (Tuttlingen, Germany) in our centre). Direct laryngoscopy with a Macintosh blade was performed in 20 cases (29%). Six cases (9%) were intubated electively with a fibreoptic scope (four awake and two asleep), although the reasons for this choice of technique were not clear. Mouth opening was quantitatively recorded in all 69 cases. There was no intubation difficulty in any of the 69 cases, and none required a 'secondary' intubation strategy. This cohort, most of whom presented with an isolated injury, represents a subset of patients with mandibular fractures. Polytrauma patients are managed at our regional trauma centre. No patients sustained C-spine injuries, similar to a previously published work, 1 showing that isolated mandibular fractures are rarely associated with C-spine injury. Despite the typical presentation with significant trismus, and despite 26% of patients having a condylar fracture, which can be associated with mechanical obstruction to mouth opening, 2 the vast majority of patients in this cohort (91%) were intubated uneventfully using either a videolaryngoscope or a standard Macintosh blade.