8 results
73y · Male·Acute on chronic renal failure and multi-factorial encephalopathy in a man with …
A 73-year-old man with significant comorbidities (cirrhosis, dilated cardiomyopathy, chronic kidney disease) died in prison from acute-on-chronic renal failure, hepatic encephalopathy, and multiorgan failure. He was init…
87y · Female·Complications following a medication administration error in a woman with multip…
An 87-year-old woman died from complications of a medication administration error at an aged care facility. During transition from paper-based to electronic medication charts in December 2020, a pharmacy data entry error…
79y · Female·Rhabdomyolysis in a woman with multiple myeloma and renal impairment
Margaret Ann Yeomans, aged 79, died from rhabdomyolysis in the context of multiple myeloma and chronic renal impairment. A critical medication error occurred when rosuvastatin 40mg was dispensed instead of her prescribed…
91y · Male·Severe heart failure secondary to ischaemic cardiomyopathy
Ernest Robert Tester, a 91-year-old man with ischaemic cardiomyopathy and severe heart failure, died in an aged care facility. He experienced chest tightness and difficulty breathing at 2am, treated appropriately by nurs…
74y · Female·haemothorax secondary to dissecting thoracic aorta
Mrs Petzierides, a 74-year-old woman, presented to the emergency department with sudden-onset, severe left scapular pain radiating to the jaw, occurring shortly after midnight. She was assessed by an emergency medicine r…
76y · Female·colchicine toxicity
A 76-year-old woman with gout died from colchicine toxicity after being prescribed 500µg three times daily on 9 December 2010 for an acute attack. She developed diarrhoea from 15 December and died on 19 December with a p…
68y · Male·Ischaemic heart disease and coronary artery atherosclerosis
Patrick Paul, a 68-year-old man with significant cardiac history including prior myocardial infarction and coronary stents, died of ischaemic heart disease while in prison custody. He presented to hospital with symptoms …
53y · Male·asphyxia from combined effects of neck compression from hanging and suffocation …
John Trenorden died by suicide in prison following his arrest for allegedly murdering his former business partner Penelope Christopher. Police correctly identified him as at-risk after he attempted to step in front of tr…
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