Coronial

134 results for blood transfusion

SAaged care2022-04-14

Coroner's Finding: Lauder, Ian Ross

80y · Male·general inanition and pneumonia on a background of advanced vascular dementia, c…

…ring surgery. During hospitalisation, he experienced a posterior cerebral artery stroke, anaemia requiring blood transfusions, gastrointestinal bleeding, and worsening delirium. Upon discharge, he continued to refuse fo…

geriatric medicineorthopaedic surgeryproton pump inhibitors
TAShospital2023-11-17

Coroner's Finding: Williams, Stewart

54y · Male·Hypoxic/ischaemic brain damage caused by blood loss and airway obstruction due t…

…te packing and initial interventions; inadequate fluid balance documentation leading to underestimation of blood loss (500ml initially unrecorded); delayed involvement of Oral Maxillofacial specialists; failure to imple…

emergency medicineoral and maxillofacial surgerydiagnosticcommunication
SAaged care2018-04-26

Coroner's Finding: MCKENNA Joseph

83y · Male·cholangiocarcinoma on a background of advanced dementia and ischaemic valvular a…

Joseph McKenna, 83 years old, died of cholangiocarcinoma with advanced dementia and cardiac disease at an aged care facility where he was detained under a guardianship order. He was appropriately managed with palliative …

geriatric medicinepalliative care
VIChospital2016-09-15

Finding into death of Bernas Hasibuan

50y · Male·gastrointestinal haemorrhage; haemorrhage from cystic artery post laparoscopic c…

A 50-year-old man died from gastrointestinal haemorrhage involving both a cystic artery and duodenal defect following laparoscopic cholecystectomy. Over five days post-surgery, he developed repeated episodes of hypotensi…

general surgeryintensive carediagnosticcommunication
NSW2018-03-07

Inquest into the death of Saker Mohamed

44y · Male·Hodgkin's Lymphoma

Saker Mohamed, a 44-year-old man serving a custodial sentence, died of Hodgkin's Lymphoma on 31 December 2015 at Long Bay Hospital. He presented with symptoms including lumps under armpits (August), headaches and dizzine…

oncologyhaematology
VIChospital2023-11-29

Finding into death of Danielle Elizabeth Peters

40y · Female·Sepsis secondary to ureteritis, pyelonephritis and aspiration pneumonia with a c…

…urrent complication in her history. Despite appropriate intravenous antibiotics, supportive care including blood transfusions and albumin, and escalation to palliative care, she deteriorated from worsening bilateral ple…

general medicineinfectious diseases
SA2025-08-28

Coroner's Finding: RJR

65y · Male·metastatic rectal cancer with extensive lung metastases

… sentence. He had presented with rectal bleeding symptoms since 2011 and returned a positive faecal occult blood test in March 2015 recommending colonoscopy. However, he subsequently declined multiple colonoscopy offers…

colorectal surgeryoncologyapixaban
SAhospital2021-11-25

Coroner's Finding: Cannell, Peter Tasman

48y · Male·Multi-organ failure from acute gastrointestinal haemorrhage associated with oeso…

…of hepatitis C, cirrhosis, thrombocytopenia, and anaemia. Clinical warning signs were present: he reported blood in stool in 2016 and black stools in 2018, both concerning for gastrointestinal bleeding. In August 2019, …

gastroenterologyhepatology
VIChospital2025-05-12

Finding into death of Francesco Fogliaro

73y · Male·Metastatic colon cancer

Francesco Fogliaro, a 73-year-old man with intellectual disability living in supported accommodation, died from metastatic colon cancer. He was found on the floor of his bedroom on 9 August 2024 with signs of infection a…

oncologypalliative care
NThospital2007-12-10

Inquest into the death of Ricky Ryder

28y · Male·hypovolemia secondary to haemorrhage from operative exploration of multiple stab…

…(4 months experience) whose consultant failed to examine the patient preoperatively; failure to check that blood had been 'group & held' despite knowing stab wounds present arterial bleeding risk; failure to call for se…

general surgeryorthopaedic surgerydiagnosticsystem
NSW2011-04-20

Johnkudrytch&melissacookfinding2422 08&2423 08

29y · Female·gunshot wound to the abdomen

…a, NSW) on 16 December 2008. She was taken to Liverpool Hospital where she underwent emergency surgery and blood transfusions for a gunshot wound to the abdomen, but died at 19:40 hours that evening. The coroner's findi…

emergency medicinesurgery
VIChospital2026-01-08

Finding into death of Malakai Cross-De Jesus

0y · Male·Complications following forceps delivery

…, improve situational awareness in neonatal resuscitation, and develop statewide guidelines for massive transfusion in neonates.

obstetricsneonatologydiagnosticcommunicationbenzylpenicillin
SAhospital2016-09-01

Coroner's Finding: CALLAGHAN Brian Francis

79y · Male·Multi-organ failure due to pneumonia and bleeding duodenal ulcer complicating su…

…irium requiring Mental Health Act detention. Despite appropriate medical management including antibiotics, blood transfusions, endoscopy with haemostasis, and nasogastric feeding, he deteriorated from multi-organ failur…

general surgeryorthopaedic surgery
VIChospital2015-10-20

Finding into death of THI DIEP ANH LU

36y · Female·Haemorrhage complicating elective caesarean section (placenta praevia accreta)

Ms. Thi Lu, aged 36, died from massive hemorrhage following caesarean section for placenta praevia with underlying placenta accreta. Although imaging could not definitively exclude accreta preoperatively, high-risk prepa…

obstetricsanaesthesiadelayprocedural
VIC2024-05-15

Finding into death of Robert Leonard Morris

76y · Male·Terminal pancreatic cancer

76-year-old Robert Leonard Morris died from terminal pancreatic cancer while serving a custodial sentence at Port Phillip Prison. He had been diagnosed with inoperable pancreatic adenocarcinoma in December 2020 and comme…

oncologypalliative caremorphine
NSWhospital2019-10-25

Inquest into the death of Peter SMITH

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…

emergency medicinegeneral practicesystemmorphine
NSWhospital2016-11-04

Inquest into the death of Hellen Marsh

50y · Female·Irreversible hypoxic brain injury sustained during surgery for meningioma resect…

…om irreversible hypoxic brain injury sustained during tumour resection surgery. Significant intraoperative blood loss (4,500ml estimated) occurred, with major discrepancies between surgical and anaesthetic team accounts…

neurosurgeryanaesthesiacommunicationmonitoring
ACThospital2024-09-11

Inquest Into The Death Of Baby X

0y · Male·Hypoxic-ischemic encephalopathy and massive subgaleal haemorrhage, both associat…

… despite visible scalp bruising from 27 minutes after birth. Delayed recognition deprived Baby X of timely blood product transfusions and contraindicated cooling therapy was inappropriately continued. CHS has since impl…

obstetricsneonatologydiagnosticcommunication
QLDhospital2017-02-28

Paddon, Darrin Edward

51y · Male·Acute myocardial infarction due to coronary atherosclerosis

A 51-year-old man with end-stage renal disease, hepatitis C cirrhosis, endocarditis, and aortic valve disease died in custody from acute myocardial infarction. He presented with gastrointestinal bleeding, pancytopenia, a…

nephrologycardiologyaspirin
SAhospital2022-03-30

Coroner's Finding: Dunn, Julie Michele

56y · Female·sepsis secondary to disseminated pancreatic adenocarcinoma

Julie Michele Dunn, a 56-year-old female prisoner, died of sepsis secondary to disseminated pancreatic adenocarcinoma. She had presented months earlier with gastrointestinal symptoms (weight loss, nausea, vomiting, epiga…

general medicineoncologydiagnostictramadol

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