149 results for “blood testing”
20y · Female·multi-organ failure due to polypharmacy overdose
…polypharmacy overdose (13 grams of paracetamol among 78 tablets). She was admitted to the ED where initial blood testing at 3 hours post-ingestion showed 757 μmol/L paracetamol (below 1000 μmol/L threshold), and NAC was…
62y · Male·Diabetic ketoacidosis in a man with coronary atherosclerosis and cardiomegaly
…ed vision, dizziness and vomiting. The GP diagnosed hypertension and suspected diabetes mellitus, ordering blood tests for the following day. No point-of-care glucose testing was performed despite classic symptoms of hy…
54y · Female·complications related to post-polio syndrome and chronic respiratory weakness; n…
…ith post-polio syndrome during respiratory transition periods, the importance of completing physiological testing during ventilator changes, and awareness of medication-alcohol interactions in patients with compromised …
Jessica: disseminated intravascular coagulation following haemorrhage (subgaleal…
…th deliveries were technically appropriate. Jessica's death may have been preventable: she required urgent blood transfusion which was ordered but not delivered before her collapse—Dr B. did not adequately follow up on …
1y · Male·Staphylococcus aureus septicaemia of unknown origin
…y, and poor oral intake. He was triaged as semi-urgent and not seen by a doctor until 5 AM, 8 hours later. Blood cultures drawn at 5:50 AM showed positive growth (Staphylococcus aureus) by 8 PM Sunday, with gram-positiv…
67y · Male·Gas gangrene with antecedent cause of Clostridium septicum septicaemia
…high mortality (>60%) regardless of management. A critical system failure identified was unavailability of blood gas cartridges when needed—only one iStat cartridge remained in stock. The coroner found that even had blo…
16y · Male·Hypoxic/ischaemic encephalopathy in the context of diabetic ketoacidosis
…ng at 8am on 26 September 2019, Lachlan was treated conservatively as gastroenteritis for 24 hours without blood glucose or ketone testing, without escalation to medical support, and without reference to his Diabetes Ac…
73y · Female·pneumonia and renal failure with hyperthermia
…her care: inadequate monitoring for dehydration despite clinical signs (severe sweating, tremors, elevated blood sugars), delayed medical review by her GP (Dr G.), inappropriate use of intramail for urgent communication…
41y · Male·Acute internal blood loss caused by laceration of the aorta in tandem with spina…
Anthony John Roach, a 41-year-old experienced motocross rider, died from acute internal blood loss caused by aortic laceration sustained during a motocross race. He lost control of his motorcycle on a…
29y · Male·Diabetic ketoacidosis
…and hypertension. The GP diagnosed a urinary tract infection and prescribed antibiotics, arranging fasting blood tests for the following day. Mr Hodgson was found deceased the next morning from diabetic ketoacidosis wit…
30y · Female·Multi-organ failure due to multiple transfusions required for post-operative ble…
…emoglobin 5.3 g/dL). Dr W. performed emergency laparotomy via midline incision, found 1-1.5 litres of 'old blood' but no obvious bleeding source. Rather than continuing systematic exploration of the abdomen via the orig…
72y · Female·haemorrhage from penetrating duodenal ulcer
… the ED doctor but not properly acted upon by the admitting medical team. Despite a positive faecal occult blood test and clinical evidence of bleeding, no endoscopy was performed. The team attributed symptoms to cardia…
17y · Male·Diabetic ketoacidosis
…hydration, but attributed his presentation to anxiety and upper respiratory infection. They did not take a blood glucose level or transport him to hospital. He died from diabetic ketoacidosis (DKA) six hours later. The …
54y · Male·multi-organ failure and sepsis complicating fulminant pneumonia with empyema (op…
…concerning signs including bilateral oedema, fever, and respiratory symptoms. The GP appropriately ordered blood tests but the appointment timing (4:36pm) meant the pathology collection centre had closed; the nearest al…
4y · Male·Severe rhabdomyolysis due to LPIN1 gene mutation
… recognise the pattern. On 30 June 2010, he presented to hospital with dark urine and abnormal urinalysis (blood and protein positive, but no red blood cells on microscopy), suggesting myoglobin rather than haematuria. …
14y · Male·Head injuries resulting from a motor vehicle collision (pedestrian)
…on occurred during civil dusk with poor visibility. While the coroner found police procedures for alcohol testing adequate and no prior footpath was required by design standards, systemic issues were identified: inadequ…
70y · Female·Cardiac arrest caused by a combination of gastric haemorrhage and pneumonia exac…
…sease. She presented with severe epigastric pain and was appropriately admitted for investigation. Initial blood tests and CT scan showed no evidence of gastrointestinal bleeding. Her symptoms improved and she was disch…
74y · Female·Diabetic ketoacidosis
…1 diabetes died from diabetic ketoacidosis (DKA) in an aged care facility. Between 7-10 December 2016, her blood glucose levels remained persistently elevated (>33 mmol/L) despite escalating insulin doses. Critical fail…
47y · Female·Cardiac arrhythmia due to severe coronary artery atherosclerosis
…tal with chest pain. The doctor diagnosed muscular pain (99% certain) and discharged her without troponin testing or admission, despite chest pain being the presenting complaint. She died of cardiac arrhythmia secondary…
81y · Male·Retropubic and retroperitoneal haemorrhage complicating pelvic fractures with co…
…l fibrillation with an excessive INR of 4.6 at the time of injury. Critical failures included: (1) no INR testing on emergency admission despite warfarin use—a routine test that would have revealed over-anticoagulation;…
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