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QLDhospital2017-08-29

Mr C - Non-inquest findings

87y · Male·Endobronchial and pulmonary haemorrhage secondary to pneumonia complicating chro…

An 87-year-old man with atrial fibrillation on warfarin underwent elective bronchoscopy for suspected lung lesion. The admitting respiratory team incorrectly documented a mechanical aortic valve replacement when he actua…

respiratory medicinecardiologydiagnosticcommunicationwarfarin
VIChome2017-08-28

Finding into death of Tara Sue Love

22y · Female·Sudden Arrhythmic Death Syndrome

Tara Love, a 22-year-old woman, died from sudden arrhythmic death syndrome due to long QT syndrome (LQTS). She presented multiple times to the Royal Women's Hospital with ECG changes and electrolyte abnormalities during …

obstetricscardiologydiagnosticcommunicationlabetalol
VIC2017-08-28

Finding into death of Frederick Hylla

87y · Male·Multiple injuries in a motor vehicle incident

Mr Frederick Hylla, 87 years old, died from injuries sustained in a motor vehicle incident 18 days after discharge from hospital for acute myocardial infarction. He suffered a likely cardiac event while driving, causing …

general practicecardiologycommunicationsystem
NSWcommunity2017-08-21

Inquest into the death of Samuel SEETO

29y · Male·Florid myocarditis

Samuel Seeto, a previously healthy 29-year-old, died from florid myocarditis after a general practitioner failed to detect his cardiac condition. He presented on 5 December 2015 with a 3-day history of fatigue, feeling c…

general practicecardiologydiagnosticcommunicationibuprofen
SAhospital2017-08-10

Coroner's Finding: HERCZEG Stephen

72y · Male·Bilateral pneumothoraces and pneumoperitoneum due to insufflation of the bladder…

Stephen Herczeg, a 72-year-old patient with COPD and urinary tract infection, died from bilateral pneumothoraces and pneumoperitoneum caused by insufflation of his bladder with oxygen. The oxygen supply tubing was someho…

respiratory medicineemergency medicinecommunicationmedicationoxygen
QLDhospital2017-07-31

Mrs NSM - Non-inquest findings

81y · Female·left haemothorax and mediastinal haemorrhage from the insertion site of the perm…

An 81-year-old woman died from haemothorax and mediastinal haemorrhage following pacemaker insertion for sick sinus syndrome. Multiple venous punctures during the procedure caused vascular injury. Critical clinical lesso…

cardiologyintensive carediagnosticcommunicationglyceryl trinitrate
QLDhospital2017-06-22

PS - Non-inquest findings

68y · Female·Coronary heart disease

A 68-year-old woman with diabetes, hypertension, hypercholesterolaemia, COPD and chronic renal failure presented with chest pain and dyspnoea. She was admitted with suspected congestive cardiac failure; troponins were no…

cardiologyemergency medicinediagnosticcommunicationfurosemide
TAShospital2017-06-16

Coroner's Finding: Baldock, Andrea Eileen

46y · Female·combined effects of aspiration pneumonia due to gastroparesis following sleeve g…

A 46-year-old woman died from aspiration pneumonia due to gastroparesis following sleeve gastrectomy, complicated by ischaemic heart disease. Post-operative recovery was beset with persistent vomiting, dehydration, and e…

general surgerygastroenterologysystemdelay
QLDaged care2017-06-09

DR - Non-inquest findings

46y · Female·Dilated cardiomyopathy (acute complication with sudden cardiac arrhythmia)

A 46-year-old woman with bipolar/schizoaffective disorder, poorly controlled type 2 diabetes, morbid obesity, severe obstructive sleep apnoea, and pulmonary hypertension died from acute dilated cardiomyopathy with sudden…

general medicineemergency medicinecommunicationsystemquetiapine
TASaged care2017-05-08

Coroner's Finding: Handasyde, Robert Neil

86y · Male·Sepsis with septic shock, due to urinary tract infection, pyelonephritis (kidney…

An 86-year-old man died from sepsis and septic shock secondary to urinary tract infection, pyelonephritis and prostatic infection. He presented to his GP in March 2015 with dizziness and reported urinary incontinence and…

general practicecardiologydiagnosticmedicationclopidogrel
WAhospitalPodcast2017-05-03

Inquest into the Death of Edith Catherine BEE

80y · Female·Gas embolism complicating surgical repair of an atherosclerotic aortic aneurysm …

An 80-year-old woman with multiple comorbidities (COPD, renal impairment, cardiac disease) underwent complex endoluminal repair of a thoracoabdominal aortic aneurysm at a private hospital. The procedure required use of C…

vascular surgerygeneral surgeryproceduralsystem
WAhome2017-04-26

Inquest into the Death of Leslie Troy OVENS

32y · Male·Asphyxia in a man with Friedreich's Ataxia due to positional asphyxia; unable to…

Leslie Troy Ovens, a 32-year-old man with progressive Friedreich's Ataxia, died from positional asphyxia after falling from his wheelchair. He had deteriorated significantly after hospitalisation in June 2013 and was wea…

neurologycardiologycommunicationsystem
ACThome2017-03-23

AN INQUEST INTO THE DEATH OF PAP

55y · Male·Septicaemia due to hydronephrosis and infection

A 55-year-old man with complex medical and social problems died of septicaemia from renal infection. He had a history of cardiac disease requiring anticoagulation, alcohol dependence, depression, and chronic hoarding beh…

cardiologypsychiatrysystemcommunicationwarfarin
NSW2017-03-17

Inquest into the death of Ronald BRIZZOLARA

60y · Male·Congestive Cardiac Failure

A 60-year-old Aboriginal man with end-stage COPD, congestive cardiac failure, and ischaemic heart disease died in prison custody. He likely suffered cardiac collapse around 8:30-9:00pm on 25 October 2014, pressed his cel…

cardiologyrespiratory medicinesystemdelay
NSWhospital2017-03-16

Inquest into the death of Bridgett CURRAH

1y · Female·aspiration of gastric contents due to recent gastroenteritis and vomiting leadin…

Bridgett Currah was a 19-month-old girl with complex medical needs including cyanotic congenital heart disease, gastro-oesophageal reflux, and feeding difficulties. She presented to Mildura Base Hospital on 21 May 2013 w…

paediatricsemergency medicinediagnosticcommunicationomeprazole
VIChospital2017-02-23

Finding into death of Goet Wo Tjoeng

71y · Female·aortic dissection (Stanford Type A)

A 71-year-old woman presented to hospital with pericardial effusion causing cardiac tamponade, successfully treated by pericardiocentesis. The underlying cause was a Stanford Type A aortic dissection, which was not ident…

cardiologyradiologydiagnosticcommunicationnoradrenaline
VIChospital2017-02-17

Finding into death of Christopher Albert Nance

67y · Male·ischaemic heart disease

A 67-year-old man with ischaemic heart disease and paroxysmal atrial fibrillation underwent arthrotomy for septic arthritis of the knee. He developed post-operative delirium attributed to anaesthesia, analgesics (tramado…

cardiologyorthopaedic surgerycommunicationproceduraltramadol
QLDhome2017-02-07

ES, a 87 year old lady

87y · Female·Multiple opioid drug toxicity (morphine and fentanyl) in combination with conges…

An 87-year-old woman with multiple comorbidities (ischaemic heart disease, emphysema, chronic kidney disease) was discharged home for palliative care after a hospital admission. Her family administered excessive doses of…

general practicepalliative caremedicationcommunicationmorphine
NT2017-01-13

Inquest into the death of Ronnie Beasley

40y · Male·ischaemic heart disease due to left ventricular hypertrophy and coronary artery …

A 40-year-old Aboriginal man with longstanding rheumatic heart disease, left ventricular hypertrophy, and coronary artery atherosclerosis died from acute myocardial infarction complicated by ventricular fibrillation whil…

cardiologyemergency medicineproceduralaspirin
QLDcommunity2016-12-21

Capps, Ruth

75y · Female·multiple injuries due to or as a consequence of motor vehicle collision

Ruth Capps, 75, died in a motor vehicle collision after drifting into oncoming traffic. She had multiple medical conditions including diabetes, sleep apnoea, chronic back pain, osteoarthritis, and recurrent falls. Despit…

general practiceoccupational therapydiagnosticcommunicationnitrazepam
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