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TAShospital2019-01-21

Coroner's Finding: Brown, Tony David

28y · Male·traumatic brain injury

Tony David Brown, 28, died from traumatic brain injury sustained during an altercation at the Mowbray Hotel in Launceston on 17 July 2013. After being asked to leave for unruly behaviour, he was struck multiple times in …

emergency medicineneurosurgeryalcohol
NSWhospital2019-01-18

Fresh inquest into the death of Jarrod Wright

Male

Jarrod Wright died at Liverpool Hospital ICU. He became restless, agitated and clinically unstable but was not placed on 1:1 nursing care as required by existing guidelines. Nursing staff felt unable to request additiona…

intensive caresystemcommunication
WA2019-01-07

Inquest into the Death of Ali JAFFARI

Male·thermal injuries (burns)

Ali Jaffari, an immigration detainee, died by suicide at Yongah Hill Immigration Detention Centre on 16 September 2015. He sustained fatal thermal injuries from a fire he deliberately started in his room. The deceased ha…

psychiatrypsychologysystemolanzapine
NSWhospital2019

Inquest in to the death of Jodie Pearson - Findings - 01 March 2019.docx Final version

47y · Female·hypoxic encephalopathy and aspiration pneumonia following aspiration of gastric …

Jodie Ann Pearson, aged 47, died from hypoxic encephalopathy and aspiration pneumonia following aspiration of gastric contents during a gastroscopy at Belmont Hospital on 15 February 2016. Critical pre-procedure informat…

general surgeryanaesthesiacommunicationsystem
VIChospital2018-12-30

Finding into death of Peter Allen Bain

31y · Male·Aspiration Pneumonia

Peter Bain, a 31-year-old man with severe intellectual disability, autism, and multiple comorbidities, died from aspiration pneumonia. He was admitted to ICU following deterioration at a DHHS residential facility and die…

respiratory medicineintensive caresodium valproate
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
NSWhospital2018-12-04

Inquest into the death of June Nutter

58y · Female·lymphangitic carcinomatosis leading to hypoxaemic respiratory failure and cardia…

June Nutter, a 58-year-old woman presenting with weight loss, anorexia, and unexplained shortness of breath, underwent gastroscopy and colonoscopy at a private hospital to investigate suspected gastric pathology. She had…

anaesthesiagastroenterologymedicationproceduralfentanyl
VIChospital2018-12-03

Finding into death of Anna Agnieszka Bowditch

34y · Female·Complications of fall with fractured ankle and subsequent deep venous thrombosis…

Anna Bowditch, aged 34, died from complications of deep venous thrombosis (DVT) with pulmonary embolism and paradoxical stroke following elective fracture repair surgery. She had multiple known DVT risk factors: immobili…

orthopaedic surgeryanaesthesiaproceduraldiagnosticclonazepam
ACThospital2018-11-29

AN INQUEST INTO THE DEATH OFSIAUTO ELIUTA TUNUMAFONO

43y · Female·cardiac arrhythmia (unascertained), probably fatal cardiac dysrhythmia

A 43-year-old woman collapsed at home and was found in cardiac arrest after 20-25 minutes. Ambulance arrived and recognised ventricular fibrillation but failed to defibrillate for approximately 20 minutes, despite protoc…

emergency medicinecardiologyproceduralsystem
VIChospital2018-11-29

Finding into death of Albert Dean May

86y · Male·Respiratory complications in a man with chronic lung disease and rib and pelvic …

Albert Dean May, an 86-year-old man with COPD and osteoporosis, sustained life-threatening injuries when struck by an electric bicycle on a footpath. He was treated at three hospitals over 12 days before dying from respi…

intensive caretrauma surgerysystemregulatory
VIChospital2018-11-28

Finding into death of Jason William Causon

46y · Male·COMPLICATIONS OF RUPTURED ANTERIOR COMMUNICATING CEREBRAL ARTERY ANEURYSM (OPERA…

Jason Causon, a 46-year-old man in custody, collapsed while exercising due to a ruptured anterior communicating cerebral artery aneurysm. He received prompt initial resuscitation by correctional and health staff, was rap…

neurosurgeryintensive care
ACThospital2018-11-26

AN INQUEST INTO THE DEATH OFADRIAN CHARLES WILFRED VAN DIE

50y · Male·Multi-organ failure caused by low flow ischaemia of coeliac artery and superior …

Adrian Van Die, a 50-year-old with severe ischaemic cardiomyopathy, underwent coronary artery bypass grafting with intra-aortic balloon pump (IABP) support. The first IABP ruptured intraoperatively and was replaced. The …

cardiothoracic surgeryintensive caresystem
NSWhospital2018-11-23

BURTON-HO Anqelique File 2015-235464 Findings given by Mag Grahame DSC on 23-11-2018

12y · Female·Cardio-respiratory failure due to aspiration pneumonia

Angelique Burton-Ho, age 12, with VACTERL syndrome and difficult airway, presented to Bowral Hospital ED on 9 August 2015 with respiratory symptoms. She was inadequately triaged initially, then readmitted that evening wi…

anaesthesiaemergency medicinediagnosticdelay
VIChospital2018-11-19

Finding into death of Robert Humphreys

71y · Male·Aspiration in setting of paralytic ileus in patient in convalescent phase of abd…

A 71-year-old man died from aspiration complicating prolonged paralytic ileus on postoperative day 9 following open abdominal aortic aneurysm repair. Despite clinical signs of persistent ileus (vomiting, abdominal disten…

vascular surgeryintensive carediagnosticdelayatropine
TAShospital2018-11-16

Coroner's Finding: Richardson, Margaret Rita

67y · Female·Right coronary artery dissection following angiography stenting and attempted ro…

Margaret Richardson, 67, died from right coronary artery dissection during rotational atherectomy on 24 January 2017 at Launceston General Hospital. She had suffered acute myocardial infarction on 14 January with 95% occ…

cardiologyintensive care
TAShospital2018-11-16

Coroner's Finding: Richardson, Margaret Rita

67y · Female·right coronary artery dissection following angiography stenting and attempted ro…

Margaret Richardson, 67, died from right coronary artery dissection during rotational atherectomy for treatment of occluded coronary artery. She had presented with ST elevation myocardial infarction and underwent initial…

cardiologyintensive care
VIChome2018-11-15

Finding into death of Timothy Aghan

52y · Male·Hypoxic ischaemic encephalopathy complicating traumatic asphyxia due to external…

A 52-year-old man died from hypoxic ischaemic encephalopathy following traumatic asphyxia when a vehicle he was working under fell on him. While working on his transmission at home, the vehicle rolled off ramps due to in…

emergency medicineintensive caresystem
VIChomePodcast2018-11-09

Finding into death of Ling-Ling Ang

47y · Female·hypoxic ischaemic encephalopathy complicating systolic cardiac arrest in the set…

Ms Ling-Ling Ang, aged 47, died from hypoxic ischaemic encephalopathy and cardiac arrest following severe allergic asthma exacerbation during the November 2016 Melbourne thunderstorm asthma epidemic. She had known asthma…

general practiceparamedicinesalbutamol
VIChospitalPodcast2018-11-09

Finding into death of Hoi-Sam Lau

49y · Male·acute asthma leading to hypoxic brain injury

Hoi-Sam Lau, 49, died from acute asthma leading to hypoxic brain injury during the unprecedented Melbourne thunderstorm asthma event of 21 November 2016. He had well-controlled asthma triggered by pollen and respiratory …

emergency medicineintensive caresystemdelaysalbutamol
VIChospital2018-11-09

Finding into death of MDJ

34y · Male·Hypoxic/ischaemic encephalopathy; Heroin toxicity

A 34-year-old man with a history of heroin abuse died from hypoxic-ischaemic encephalopathy following heroin toxicity after injecting in a public park. He presented to hospital unresponsive with Glasgow Coma Score 3 and …

intensive careemergency medicineheroin
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