3,478 results
5y · Male·Combined effects of prescribed morphine, valproic acid and midazolam leading to …
A five-year-old child with complex neurodevelopmental conditions and polypharmacy (including valproic acid for epilepsy, benzodiazepines, and other medications) underwent routine burn dressing change at hospital with ora…
86y · Female·Sepsis complicating sacral decubitus ulceration in the setting of recent surgica…
Mrs Di Quinzio, an 86-year-old woman with multiple comorbidities, was discharged from hospital to a supported residential service (SRS) after hip fracture surgery. She required two-person assistance for mobility and was …
93y · Male·Multisystem failure complicating sepsis secondary to perforated viscus
Ward Harker, 93 years old, died in the Alfred Hospital on 1 December 2015 from multisystem failure complicating sepsis following a perforated bowel. He was receiving palliative care. His grandson, Angus Tye, told nursing…
44y · Female·Combined drug toxicity (elevated pregabalin, temazepam, oxazepam, ibuprofen, mel…
Caitlin-Lei Alaya, a 44-year-old woman with fibromyalgia, PTSD, depression and suicidal ideation, died from combined drug toxicity (elevated pregabalin, temazepam, ibuprofen, meloxicam). She survived a suicide attempt on…
35y · Male·Multiple injuries from motor vehicle collision, with significant contributing co…
A 35-year-old man died following a motor vehicle collision that occurred during a police pursuit initiated at a random breath testing site. He was driving under the influence of methylamphetamine and morphine, which sign…
87y · Female·Hypoxic-ischaemic encephalopathy secondary to cardiac arrest, with valvular hear…
An 87-year-old woman died following a CT-guided epidural injection at a private radiology clinic. Although she had undergone the procedure for spinal pain, the radiologist performed an epidural injection at the T12 level…
18y · Male·Incised wound to right axilla with complete transection of basilic vein, brachia…
Thomas Redman, aged 18, sustained a catastrophic laceration to his right axilla involving complete transection of major arteries and veins after putting his arm through a glass window at a rural property near Gloucester,…
59y · Male·Electrocution
Guy Redman Clark, a 59-year-old facilities manager, died from electrocution while attempting to remove a coffee machine at a café. When the water hose dislodged during removal, he attempted to reconnect a glass washing m…
Unknown·asphyxiation in a child with drug effect
Two young children, aged 5 and 3, died following filicide by their father during a parental separation. The father purchased sedative medication (Restavit) on the afternoon of the deaths and administered it to the childr…
35y · Male·Hanging
Travis Lee Fernandez, aged 35, died by hanging in custody at Dhurringile Prison in November 2014. He had sustained bilateral mandibular fractures in January 2014 treated with open reduction and internal fixation (ORIF). …
46y · Female·Combined drug toxicity in a woman found in a bath
A 46-year-old woman with borderline personality disorder and bipolar affective disorder type 2 died from combined drug toxicity. She had a long history of overdose attempts, often without clear suicidal intent, and was u…
8y · Female·Aspiration pneumonia in a child with an epileptic encephalopathy and extreme cac…
HB, age 8 years 10 months, died from aspiration pneumonia with extreme cachexia (BMI 7). She had severe cerebral palsy, epilepsy (Lennox-Gastaut syndrome), and was entirely dependent on PEG tube feeding. Between January …
74y · Female·Subdural haemorrhage following a fall in a woman with multiple medical comorbidi…
Mrs Chettle, a 74-year-old aged care resident with multiple comorbidities including dementia, schizoaffective disorder, and a nine-fall history in twelve months, fell from a shower chair while a personal care assistant b…
23y · Male·sea snake bite with neurotoxic venom causing neuromuscular paralysis and respira…
Harry Evans, a 23-year-old deckhand from England, died from neurotoxic sea snake envenomation while working on a prawn trawler in the Gulf of Carpentaria. Bitten on the finger at 8:20am, he developed progressive neuromus…
46y · Male·cardiac arrhythmia in a man with coronary arteriosclerosis and myocarditis
Jason Mallett, a 46-year-old man with bipolar affective disorder and schizo-affective disorder, died from cardiac arrhythmia secondary to coronary arteriosclerosis and myocarditis while an involuntary psychiatric patient…
60y · Female·neck compression by ligature strangulation
Martina Morgan, aged 60, died from ligature strangulation by her own leggings while in police custody at Sturt Police Station in March 2015. She was significantly intoxicated (BAC 0.23%) and taking benzodiazepines when a…
Female·Hanging
This finding concerns the deaths of TC, a young mother, and SN, her 17-month-old daughter, who died by hanging on 21 September 2015 in Campsie, NSW. SN had significant life-limiting medical conditions including bilateral…
61y · Female·multi organ failure due to abdominal sepsis
Lesley Arndell, aged 61, died from multi-organ failure due to abdominal sepsis after undergoing a Whipple's procedure for pancreatic cancer. Key clinical lessons include: (1) patients with previous bariatric surgery requ…
76y · Male·Drowning
Yousif Yousif, a 76-year-old man with dementia, wandered away from an unsuitable Christmas party venue at a community health centre and drowned in a nearby creek. Key failures included: inadequate risk assessment for ven…
27y · Male·ligature strangulation
A 27-year-old male with treatment-resistant schizophrenia died from ligature strangulation by a co-patient at a secure forensic mental health facility. The deceased had multiple admissions for medication non-compliance a…
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