Deceased
Master T
Demographics
3y, male
Date of death
2019-08-06
Finding date
2021-03-19
Cause of death
Hypoxic brain injury secondary to cardiorespiratory arrest, possibly secondary to sepsis; likely aspiration pneumonitis
AI-generated summary
Master T, aged 3 years, died from hypoxic brain injury secondary to cardiorespiratory arrest, likely due to aspiration pneumonitis. He had severe congenital abnormalities including holoprosencephaly with VP shunt, anal atresia, oesophageal atresia, and developmental delay. He was admitted to hospital on 3 August 2019 with a 2-3 day history of unwellness, vomiting, and feed refusal. After appropriate assessment including CT brain and blood tests, he was discharged. That night he aspirated while sleeping and suffered cardiorespiratory arrest. The coroner found the assessment and discharge decision appropriate, the hospital care attentive and competent, and his foster carer's management exemplary. No clinical errors or preventable factors were identified.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.
Specialties
Drugs involved
Clinical conditions
Procedures
1y · Female·infarction and volvulus of the small intestine due to adhesion from prior nephre…
A 19-month-old girl with history of Wilms tumour presented to Launceston General Hospital with vomiting, pain and lethargy. A Children's Early Warning Tool score of 6 triggered mandatory protocols including senior doctor…
0y · Unknown·sepsis leading to multiple organ failure syndrome
A 48-day-old neonate with congenital heart defect presented to the ED with fever and vomiting on 20 September 2019. Initial triage as Category 3 was inappropriate; the child required urgent assessment. The ED intern saw …
8y · Male·acute exacerbation of chronic asthma
An 8-year-old boy with undertreated chronic asthma presented to North West Regional Hospital with acute exacerbation. Initial assessment underestimated severity. Despite initial improvement with salbutamol, ipratropium a…
Source and disclaimer
This page reproduces or summarises information from publicly available findings published by Australian coroners' courts. Coronial is an independent educational resource and is not affiliated with, endorsed by, or acting on behalf of any coronial court or government body.
Content may be incomplete, reformatted, or summarised. Some material may have been redacted or restricted by court order or privacy requirements. Always refer to the original court publication for the authoritative record.
Copyright in original materials remains with the relevant government jurisdiction. AI-generated summaries and tagging are for educational purposes only, may contain inaccuracies, and must not be treated as legal documents. We welcome feedback for correction — report an inaccuracy here.