Deceased
Johann George Mynhart
Demographics
77y, male
Date of death
2000-05-01
Finding date
2003-01-10
Cause of death
bilateral pulmonary emboli complicating deep vein thrombosis (left calf)
AI-generated summary
A 77-year-old man with dementia died from bilateral pulmonary emboli complicating deep vein thrombosis of the left calf. He was hospitalised for dehydration and diabetes management, then returned to psychiatric care. On 30 April, his daughter observed classic DVT signs (unilateral leg swelling, calf tenderness, redness, and pitting oedema). Nursing staff documented the oedema but failed to alert medical staff. The duty doctor was not contacted despite clear clinical indicators warranting urgent investigation and anticoagulation. While the DVT likely formed during his hospital stay due to immobility and dehydration, it went undiagnosed at Glenside until too late. The critical failure was nursing staff's decision not to escalate findings to medical staff when classic DVT symptoms were evident and the patient was known to be immobile.
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Specialties
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