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Limitations One of the main limitations of our audit is the lack of patient follow-up data post discharge to monitor the progress of the patients. Mechanism of injury It is important to note for the following results that due to the relatively small numbers of injuries and patients audited, we can only comment on general trends in injuries as no statistical significance was noted. Keywords: airway obstruction; audit; (nasal/maxillofacial) trauma; naso-pharynx; public health; research; stridor; swallowing EN airway obstruction audit (nasal/maxillofacial) trauma naso-pharynx public health research stridor swallowing 259 263 5 02/21/23 20230301 NES 230301 Key points A 28-month retrospective review from February 2019 to April 2021 of penetrating neck injuries (PNIs) at our trauma centre revealed a 48% (n = 25 to n = 37) increase in PNIs "post-lockdown" (lockdown date = 23 March 2020). [Extracted from the article]

The COVID-19 pandemic has resulted in a significant increase in the number of tracheostomised patients in hospitals requiring ventilatory support. These patients require highly specialist care, but overwhelmed hospital systems with stretched human resources potentially leave these patients cared for by undertrained healthcare professionals. We describe a rare complication where a routine COVID-19 swab done incorrectly via a tracheostomy tube, resulted in a snapped-off swab in the trachea. We outline the events and our method of removal using rigid bronchoscopy through the tracheostomy stoma as endo-tracheal bronchoscopy was impossible due to significant sub-glottic stenosis. This case highlights the paramount importance of the unique care needed to safely manage tracheostomies during this ongoing pandemic. Introduction Since emerging in the early part of 2020, there have now been over 175 million cases of Coronavirus Disease 2019 (COVID-19) caused by the SARS-CoV-2 virus worldwide [1]. In the UK, over half a million people infected with the virus have been admitted to hospital [2] to manage the severe respiratory illness that can be caused by the infection. The NHS has had to rapidly adapt in response to the pandemic which has involved: creating double the number of pre-pandemic intensive care unit (ICU) beds; redeploying staff to undertake less familiar job roles; and requiring nurse to patient ratios to increase. There have been high numbers of patients needing tracheostomies for both the short and longer term management of the illness. Traditionally, these patients have been cared for in specified areas of the hospital with appropriate trained staff. However, the adjustments of the healthcare system have meant the model of care of tracheostomies prior to the pandemic is now not always possible. Our South London Trust now regularly tests all inpatients, including those with tracheostomies, for COVID-19. We use the Virocult® swab manufactured by Medical Wire & Equipment Ltd. (Corsham, UK) to test patients using the polymerase chain reaction (PCR) method. This swab is designed for sampling from the nose and throat, with the plastic swab including a break point enabling the tip to be snapped-off and contained with the culture medium for transport to the lab. We describe a complication whereby a patient with a tracheostomy was routinely tested for the virus incorrectly via the tracheostomy tube resulting in the swab breaking at the breakpoint and falling into the airway. Although this has been described previously [3] we encountered challenges in retrieving the foreign body and took a unique approach to successfully do so. [ABSTRACT FROM AUTHOR]