MalfunctionLIX
ONESTEP
Received Jan 22, 2025 · Event occurred Jan 2, 2025
Report 21207198 · MDR key 21207198
Device
Generic name
Aid, Cardiopulmonary Resuscitation
Manufacturer
Zoll Medical CorporationModel number
8900-0224-01Lot number
2924K
Patient
73 YR · Female
- No Clinical Signs, Symptoms or Conditions
- No Clinical Signs, Symptoms or Conditions
Narrative
Description of Event or Problem
DURING CODE BLUE DEFIBRILLATOR PADS PACK WAS PULLED FROM THE CRASH CART TO BE PLACED ON THE PATIENT. UPON OPENING THE PACK, THE PADS WERE STUCK TO THE PACKAGING ALMOST LIKE THEY WERE MELTED TO IT WHICH CAUSED A DELAY IN CARE BECAUSE WE HAD TO GRAB A SECOND PACK FROM THE CRASH CART. THE FIRST PULSE CHECK WAS MISSED IN ACCORDANCE WITH ACLS (ADVANCED CARDIAC LIFE SUPPORT) PROTOCOL.