BEUDAMED
    FDA Adverse Event Injury Summary report: N

    KING LT-D

    MDR report key: 1407142 · Received June 19, 2009

    Report

    Report Number
    MW5011627
    Event Type
    Injury
    Date Received
    June 19, 2009
    Date of Event
    June 3, 2009
    Report Date
    June 19, 2009
    Manufacturer
    KING SYSTEMS CORP
    Product Code
    CAE
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OR, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    E35 RESPONDED TO A CARDIAC ARREST CALL IN THE PARKING LOT. PRIOR TO ARRIVAL PRIVATE AMBULANCE SERVICE PLACED A KING AIRWAY DEVICE AND INITIATED CPR. AFTER AMBULANCE SVC ARRIVED, THE PT WAS MOVED TO THE GURNEY AND THEN TO THE AMBULANCE FOR CONTINUED CARE. THE FIRE LT WAS RESPONSIBLE FOR THE AIRWAY AND NOTICED THE INFLATION BULB ON THE AIRWAY DEVICE TO BE FLAT. HE IMMEDIATELY CHECKED WITH THE PARAMEDIC WHO PLACED THE DEVICE AND SHE CLEARLY STATED THE DEVICE HAD BEEN INFLATED AND THE SYRINGE REMOVED UPON PLACEMENT. WITH CONSIDERATION GIVEN TO A PREVIOUS CARDIAC ARREST CALL THAT MORNING IN WHICH A SUSPECTED FAULTY KING AIRWAY COULD NOT MAINTAIN CUFF PRESSURE, THE FIRE LT. DECIDED TO PULL THE KING AIRWAY AND INTUBATE WITH AN ETT. THE PT WAS SUCCESSFULLY INTUBATED WITHOUT COMPLICATION. IT SHOULD BE NOTED THAT THE KING AIRWAY DEVICE IN QUESTION HAD THE SYRINGE CONNECTION PORT PULLED OFF IN THE PROCESS OF EXTUBATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KING LT-D KING LARYNGEAL AIRWAY CAE KING SYSTEMS CORP KING LT-D

    Patients

    Seq Age Sex Outcome Treatment
    1 Disability