22 results
39y · Female·Respiratory failure in the setting of aspiration pneumonia in a woman with arthr…
Nicole Kateiva, a 39-year-old woman with arthrogryposis multiplex congenita, intellectual impairment, and epilepsy, died from respiratory failure due to aspiration pneumonia. She presented to hospital with two days of co…
69y · Male·septic shock with multi-organ failure in a man with neutropenic sepsis on a back…
Colin Nicholson, a 69-year-old man, died from septic shock with multi-organ failure due to acute myeloid leukaemia (AML). Missed opportunities occurred at multiple levels: the PathWest laboratory scientist failed to refe…
48y · Female·Pneumonia with anaphylaxis (treated), cerebral palsy, and epilepsy as contributi…
Narelle Sanders, a 48-year-old woman with cerebral palsy and epilepsy living in disability accommodation, died of pneumonia complicated by anaphylaxis. She was admitted with shortness of breath and cough following recent…
64y · Female·COVID-19 and aspiration pneumonia in a woman with cerebral palsy
Ms N, a 64-year-old woman with cerebral palsy, dysphagia, and recurrent aspiration pneumonia, died from COVID-19 complicated by aspiration pneumonia. She presented with fever and hypoxia, tested positive for COVID-19, an…
63y · Female·Sepsis with multiorgan failure in the setting of limb cellulitis complicating a …
A 63-year-old woman with multiple comorbidities (obesity, chronic lung disease, obstructive sleep apnoea, prior cerebrovascular disease with hemiparesis) sustained a 4cm laceration to her right shin from a motorised whee…
60y · Female·sepsis due to community acquired pneumonia
Lynne Patricia Fisher, 60, presented to Mount Barker Hospital ED on 26 September 2018 with bilateral community-acquired pneumonia and was discharged after 6.5 hours despite clinical deterioration. She collapsed at home w…
79y · Male·Pneumonia, due to or as a consequence of emphysema (chronic obstructive pulmonar…
Herbert Charles Hilsley, aged 79, died of pneumonia secondary to emphysema with contributing ischaemic heart disease while incarcerated at Rockhampton Base Hospital. He had extensive comorbidities including COPD, ischaem…
81y · Male·Head injury sustained in a fall
Michele Valentino, 81, died from a head injury sustained in a fall on 20 December 2019, with death occurring on 24 December 2019. A CT angiogram at 3:45pm showed worsening intraventricular haemorrhage (IVH) that was not …
83y · Female·Acute on chronic renal failure secondary to infectious exacerbation of chronic o…
An 83-year-old woman with chronic obstructive pulmonary disease and chronic renal failure died from acute-on-chronic renal failure complicated by infectious exacerbation of COPD. She presented to hospital on 13 October 2…
6y · Male·Sepsis due to melioidosis
A six-year-old previously healthy boy died from sepsis due to melioidosis after multiple presentations to a remote hospital over five days (5–10 January 2017) with fever, vomiting, diarrhoea, and headache. Initial diagno…
80y · Female·sudden cardiac arrest due to multiple post-operative complications including myo…
An 80-year-old woman died from multiple post-operative complications following reversal of a Hartmann's procedure for diverticulitis. She had undergone a complex 8-hour surgery complicated by extensive adhesions (frozen …
47y · Male·Pulmonary thrombo-embolism secondary to deep vein thrombosis in setting of morbi…
A 47-year-old man with morbid obesity presented with respiratory failure, productive cough, and calf swelling. His GP appropriately suspected both pneumonia and pulmonary embolism (PE), requesting urgent CTPA. At Townsvi…
24y · Male·Hypoxic-ischaemic encephalopathy, due to or as a consequence of cardiac arrest, …
Hamid Khazaei, an Iranian asylum seeker aged 24, died on 5 September 2014 after contracting a leg infection (Chromobacterium violaceum) on Manus Island while in immigration detention. His death was preventable and result…
85y · Male·pneumonia
An 85-year-old man with multiple comorbidities (ischaemic heart disease, COPD, atrial fibrillation, dementia) died from pneumonia while in custody at Port Phillip Prison. He developed a lower respiratory tract infection …
3y · Male·thrombotic microangiopathy
A 3-year-old child died from thrombotic microangiopathy (haemolytic uraemic syndrome) secondary to Shiga toxin-producing E. coli infection, likely acquired from consumption of unpasteurised milk. Early presentation to GP…
82y · Male·Pneumonia on a background of severe mixed Alzheimer's and vascular dementia
An 82-year-old man with severe mixed Alzheimer's and vascular dementia died of pneumonia while detained under a Mental Health Act Level 2 Inpatient Treatment Order at a specialized psychogeriatric facility. He had been t…
44y · Male·pneumonia (with multiple left-sided rib fractures as the antecedent cause)
Jimmy James, a 44-year-old man, died from pneumonia with multiple left-sided rib fractures secondary to a physical assault. He presented to Westmead Hospital ED with clinical signs of septic shock (tachypnoea, hypoxia, h…
63y · Male·Multisystem organ failure, pneumonitis and sepsis; complications arising from a …
A 63-year-old man died on 11 March 2008 from multisystem organ failure, sepsis and pneumonitis following a fall. He was admitted to Dandenong Hospital with rib fractures and pelvic injuries. Clinical deterioration occurr…
58y · Female·pneumonia and cardiac failure complicated by hypoxic brain injury
A 58-year-old woman with autism and severe intellectual disability died from pneumonia and cardiac failure complicated by hypoxic brain injury following cardiac arrest. She had been institutionalised at Graylands Hospita…
9y · Male·Disseminated melioidosis
William Bligh, a 9-year-old boy from Palm Island, died from disseminated melioidosis on 24 February 2013. He presented with fever and cough from 2 February, initially assessed as viral illness. Over 11 days, he was revie…
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