Finding into death of Lilian Isabella Lister
Deceased
Lilian Isabella Lister
Demographics
87y, female
Date of death
2021-04-30
Finding date
2024-07-11
Cause of death
Haemorrhage secondary to an ulcerated varicose vein
AI-generated summary
An 87-year-old woman died from haemorrhage secondary to an ulcerated varicose vein on her right leg. She had known venous insufficiency documented by duplex scan in November 2020, but no specific management plan for bleeding risk was implemented. She was found deceased at home after likely experiencing acute bleeding from the varicose vein ulcer. The coroner emphasised that fatal varicose vein rupture is rare (0.01% of deaths), but prevention is straightforward: rest, elevation, and direct pressure. The key clinical lesson is that patients with documented varicose veins and venous ulcers should receive clear written first aid instructions for acute bleeding, and public health education about this simple life-saving intervention should be widely disseminated.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Contributing factors
- Documented venous insufficiency with deep venous reflux
- Known varicose veins with venous ulcer over medial right ankle
- Pre-existing cardiac conditions (paroxysmal atrial fibrillation, ischaemic heart disease, congestive heart failure) that may have exacerbated acute anaemia from blood loss
- Lack of patient education regarding acute bleeding management
Coroner's recommendations
- First aid advice for varicose vein bleeding (lie down, raise leg, apply direct pressure) should be broadly communicated to the general public via public health channels, including the Better Health website
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