Coronial

17 results for IV line insertion

VIChospital2015-04-29

Finding into death of John Manias

63y · Male·Multisystem organ failure, pneumonitis and sepsis; complications arising from a …

… with septic shock secondary to staphylococcus aureus pneumonia. The infection likely originated from an IV line noted to be inflamed on 4 March and redened/swollen on 9 March, without further investigation. The coroner …

trauma surgeryorthopaedic surgerydiagnosticcommunicationceftriaxone
NSWhospital2014-05-09

Inquest into the death of Tama GALIERE

0y · Unknown·focal ventricular myocarditis and myonecrosis resulting from migration of a Peri…

A 10-month-old boy died from myocarditis and myonecrosis caused by migration of a PICC line into his right ventricle. The line was inserted appropriately under general anaesthetic for IV antibiotics …

paediatricsanaesthesiaproceduralcommunication
VIChospital2023-04-14

Finding into death of John Edward Hadland (Millar)

38y · Male·abdominal and chest sepsis complicating iatrogenic left pneumothorax and laparot…

…ncy surgery. Post-operatively he aspirated, developed aspiration pneumonia and septic shock. During central line insertion for inotrope support, an iatrogenic left pneumotharax occurred. The coroner found the care provid…

surgeryintensive careproceduralsystemmacrogol
WAhospital2009-09-11

Inquest into the Death of Gordon

1y · Female·pneumonia (staphylococcal pneumonia with bilateral bacterial pneumonia)

…ay before parenteral antibiotics were administered and a 4-hour delay before IV fluids were started. The IV line subsequently tissued and was never successfully restarted. She was transferred by RFDS aircraft but deterio…

general practiceemergency medicinediagnosticdelayparacetamol
NSWhospital2018-08-24

Inquest into the death of Phillip Ibrahim

39y · Male·Hypoxic/Ischaemic Encephalopathy due to Cerebral Arterial Gas Embolism

…dday but the device remained in place for 6+ hours while Phillip sat out of bed with family visitors. An IV line disconnected from the Multi Flow Extension Set, allowing air entry into the CVAD. Critical failures include…

intensive careemergency medicinecommunicationprocedural
VIChospitalNew2026-07-01

Finding into death of HJW

69y · Female·Urosepsis secondary to anuric acute renal failure and corona radiata infarct; co…

A 69-year-old diabetic woman presented to Maroondah Hospital Emergency Department on 9 June 2024 with severe right-sided abdominal pain and vomiting. CT imaging at 10:00am confirmed emphysematous pyelitis (gas-forming ki…

emergency medicinegeneral medicinediagnosticdelayfentanyl
VIChospital2024-12-09

Finding into death of Gretchen Heidi Anastasia Van Lunenburg

45y · Female·COVID pneumonia complicated by severe electrolyte abnormalities

… then COVID-19 infection. Difficult venous access due to contractures prevented adequate IV access and PICC line insertion, limiting ability to monitor and replace electrolytes. The team appropriately decided against inv…

oncologygeneral medicine
WAhome2012-06-29

Inquest into the Death of Operation Lantana

Toxicity from intravenous caesium, DMSO, and other substances administered as pa…

In May 2005, the Kathi Preston Memorial Health Centre (KPMHC) operated an unproven cancer therapy clinic from Dr B.'s home in Perth, Western Australia, administering intravenous treatment containing caesium, DMSO, and La…

general practiceoncologydiagnosticproceduralcaesium chloride
QLDhospital2018-07-30

Matthew Douglas McLachlan - Non-inquest findings

28y · Male·Mixed drug toxicity (synergistic effects of diazepam, oxycodone, and fentanyl ca…

Matthew McLachlan, a 28-year-old paraplegic with chronic pain from spinal cord injury, died from mixed drug toxicity while hospitalized for urinary tract infection treatment. He was receiving fentanyl patches, oxycodone,…

infectious diseasesemergency medicinecommunicationsystemfentanyl
VIChospital2024-09-26

Finding into death of FH C

11y · Male·Sepsis

An 11-year-old boy with autism spectrum disorder (ASD level 3), ADHD, and obesity died from sepsis on 20 June 2022. He presented to Rosebud Hospital ED on 14 June with fever, vomiting, and low blood pressure, was dischar…

emergency medicinepaediatricsdiagnosticcommunicationrisperidone
VIChospital2023-10-30

Finding into death of BCT

2y · Unknown·Hypoxic-ischaemic encephalopathy following sepsis related to abdominal surgical …

BCT was a 2-year-old Aboriginal child with complex needs from a genetic disorder (CAMTA1 mutation) who died from hypoxic-ischaemic encephalopathy following sepsis related to bowel perforation after a percutaneous endosco…

gastroenterologyradiologydiagnosticcommunicationceftriaxone
NSWhospital2018-12-17

Inquest into the death of Jarrod Wright

42y · Male·Cardiac arrest following hypoxic ischaemic encephalopathy, likely due to E.coli …

Jarrod Wright, a 42-year-old man admitted with cellulitis, developed sepsis-related acute respiratory distress syndrome (ARDS) requiring ICU care with non-invasive ventilation. Critical failures occurred in managing his …

intensive careinfectious diseasescommunicationsystemmeropenem
WAhospital2005-12-09

Inquest into the Death of Laura Marguerite Sinclair

31y · Female·Post-partum Haemorrhage associated with Amniotic Fluid Embolism and Uterine Hypo…

Laura Marguerite Sinclair, 31-year-old primigravida, died from post-partum haemorrhage associated with amniotic fluid embolism (AFE) and uterine hypotonia. She underwent emergency caesarean section for foetal distress at…

obstetricsanaesthesiadiagnosticcommunicationpethidine
WAhospital2005-09

Inquest into the Death of Maria Donatelli

72y · Female·Peritonitis due to perforated diverticulum in transverse colon

Maria Donatelli, a 72-year-old woman with cardiac and renal disease, presented to Peel Health Campus with abdominal pain and vomiting. She was initially managed conservatively with a provisional diagnosis of pancreatitis…

general surgeryemergency medicinediagnosticcommunicationtramadol
SA2000-06-16

Coroner's Finding: CARTER Marshall Freeland

19y · Male·heroin toxicity

Marshall Carter, 19, died in custody from heroin toxicity at Yatala Labour Prison. He had a long history of drug abuse starting from age 14 and was an intravenous heroin user. Critical failures included: inadequate trans…

forensic medicineemergency medicinediagnosticcommunicationheroin
WAhospital2020-12-01

Inquest into the Death of Tahlia Rose BEMBRIDGE

4y · Female·volvulus of the large intestine

Tahlia Rose Bembridge, a 4-year-old with Down syndrome and prior mid-gut volvulus, presented to Bunbury Hospital ED with vomiting and abdominal pain on 1 October 2015. Initial assessment excluded acute bowel obstruction.…

paediatricsemergency medicinecommunicationdelay
NSWcommunity2019-10-04

Inquest into the death of Olivia INGLIS

27y · Female·chest injuries

…ce); (3) course design shortcomings where fence 8A/8B featured a vertical with downhill approach, no ground line, ambiguous stride distance, and lacked frangible technology—features inconsistent with risk-minimisation pr…

emergency medicineparamedicinesystemcommunication

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.