Coronial

148 results for ICU admission

VIChospital2024-07-30

Finding into death of Jason Nicholas Hosie

48y · Male·Aspiration pneumonia in a man with Angelman syndrome

…italized. Despite IV antibiotics and supplemental oxygen, his condition deteriorated. He was transferred to ICU on 6 January and placed on palliative care on 7 January. The Disability Services Commissioner investigated …

neurologyrespiratory medicine
QLDhospital2017-10-06

Parsons, Ann

59y · Female·Global cerebral oedema due to hypoxic cerebral ischaemia following cardiac arres…

…erative complications included ischaemic stroke confirmed on imaging. Despite this, she was discharged from ICU after only 22 hours with inadequate communication of the CT findings and uncertain observation frequency on…

neurosurgeryintensive carediagnosticcommunicationdexamethasone
NSWmental health2025-08-13

Inquest into the death of Allyson Bailey

42y · Female·pneumonia with diffuse alveolar damage in the setting of mixed drug toxicity (Ba…

…ilst in seclusion in a mental health unit. Critical clinical failures included: inappropriate transfer from ICU to a mental health ward without adequate consultant-to-consultant discussion; inadequate physical observati…

emergency medicineintensive carediagnosticcommunicationbaclofen
VIChospital2011-12-16

Finding into death of Lorraine Valerie McDonald

75y · Female·hypovolaemic shock from excessive blood loss

…ing during an anterior resection for rectosigmoid adenocarcinoma. Critical deficiencies included: no pre-admission clinic assessment, no formal preoperative anaesthetic evaluation, failure to perform MRI staging as reco…

general surgerycolorectal surgerydiagnosticprocedural
SAhospital2022-08-15

Coroner's Finding: Larchin, John

87y · Male·infective exacerbation of chronic obstructive lung disease

…lung disease presenting acutely postoperatively; early recognition of hypoxia and appropriate escalation to ICU was undertaken correctly.

orthopaedic surgerypsychiatryhaloperidol
NSWhospital2019-12-19

Inquest into the death of Lesley ARNDELL

61y · Female·multi organ failure due to abdominal sepsis

…1) patients with previous bariatric surgery require formal nutritional assessment before major surgery, particularly regarding protein/albumin levels; (2) when sepsis develops post-operatively, antibiotic selection shou…

general surgeryintensive caremedicationcommunicationpiperacillin/tazobactam
NSWhospital2020-09-25

Inquest into the death of Gregory MASTERS

52y · Male·Polypharmacy overdose of amitriptyline and doxylamine in the context of underlyi…

… pain, depression, obesity, cardiovascular disease and obstructive sleep apnoea died following restraint in ICU. He had ingested a polypharmacy overdose of amitriptyline and doxylamine on 26-27 February 2017, was admitt…

intensive carepsychiatryamitriptyline
VICcommunity2012-08-16

Finding into death of Janice King

45y · Female·Epilepsy

…and limited neurological recovery. Blood levels of sodium valproate and phenytoin were subtherapeutic on admission. The Clinical Liaison Service found no identifiable association between cause of death and healthcare ma…

intensive careemergency medicinesodium valproate
NSWhospital2021-10-12

Inquest into the death of Bruce HODGES

78y · Male·cardiorespiratory failure due to complications of tracheal stenosis

…gery, presented to hospital with progressive shortness of breath and tracheal stenosis. Over 48 hours of admission, his respiratory rate fluctuated between normal and elevated levels despite a critical 4mm airway narrow…

emergency medicineENT surgerydiagnosticsystemnebulised saline
SAhospital2020-11-03

Coroner's Finding: WHISKEY Louise Kitty

51y · Female·community acquired pneumonia

…ing an Inpatient Treatment Order. On 6 September, her condition deteriorated rapidly with sepsis, requiring ICU admission and intubation. During treatment, an Acomed infusion pump failed silently, temporarily compromisi…

intensive carepsychiatrysystemnoradrenaline
VIChospital2024-07-29

Finding into death of Shane Anthony Pappas

54y · Male·quetiapine toxicity in a man with ischaemic heart disease

…ts within 72 hours. The Coroner found several key deficiencies in his mental health management: the initial ICU psychiatrist's assessment was inadequate, failing to comprehensively explore his suicidal ideation and with…

psychiatryemergency medicinediagnosticcommunicationquetiapine
VIChospital2017

Finding into death of Mary Fillipas

75y · Female·Complications of multiple injuries sustained when struck by a car (pedestrian)

… serious injuries including subarachnoid haemorrhage and spinal and rib fractures, requiring intubation and ICU admission with multiple surgeries. Despite maximal treatment over three weeks, her condition declined with …

trauma surgeryintensive care
VIChospital2016-05-19

Finding into death of Josip Dobrovoljski

62y · Male·Global cerebral ischaemia secondary to intra-operative hypotension following the…

…d: incomplete anaesthetic charting of the initial protamine reaction, absent handover communication between ICU and EP laboratory staff, no completion of Surgical Safety Checklist or Time Out before the ablation, and th…

anaesthesiacardiologydocumentationcommunicationprotamine
VIChospital2014-05-28

Finding into death of Margaret Webber

48y · Female·Aspiration of stomach contents and pneumonia, following cardiac arrest

…ministered, Ms Webber vomited and aspirated while clinicians were attempting to insert an arterial line for ICU-level monitoring. The aspiration led to cardiac arrest and death. The coroner found the death was not preve…

emergency medicineendocrinologyinsulin infusion
NThospital2002-09-27

Inquest into the death of Sylvester Nawirridj

24y · Male·multiple organ failure resulting from a closed head injury

A 24-year-old Aboriginal man died from multiple organ failure following a closed head injury sustained during a domestic violence incident. After an argument at a licensed club, the deceased and his wife returned home in…

emergency medicineintensive care
TAShospital2021-11-29

Coroner's Finding: Bennett, Anthony George

77y · Male·shock due to bowel ischaemia following massive blood loss due to bleeding of the…

…ernal iliac artery after elective abdominal aortic aneurysm repair. The initial surgery was technically difficult but performed uneventfully. Post-operative bleeding required transfusion and ICU admission. Despite appro…

vascular surgerycardiology
NThospital2024

Inquest into the death of Road Death 60 of 2024

74y · Male·Complications of multiple blunt force injuries sustained in a motor vehicle cras…

…st, haemopneumothorax, spinal fractures, and retroperitoneal haemorrhage. Despite initial stabilization and ICU admission at Royal Darwin Hospital, his severe underlying chronic obstructive pulmonary disease complicated…

trauma surgeryintensive carealcohol
VIChospital2022-11-29

Finding into death of Paul Desmond Smith

58y · Male·complications of large bowel pseudo-obstruction

… to the ED with lower abdominal pain and severe faecal loading (bowel dilation 19cm). Despite a critical admission one year prior requiring ICU and manual disimpaction, and clear risk factors for recurrent obstruction, …

general surgerycolorectal surgerydiagnosticcommunicationmacrogol
NSWhospital2022-12-01

Inquest into death of RW

64y · Male·Pulmonary thromboembolus as a result of bilateral deep vein thrombosis which dev…

RW, a 64-year-old with chronic ischaemic heart disease, suffered traumatic brain injury from an intentional motorcycle collision and underwent emergency neurosurgery. He was subsequently treated with unfractionated hepar…

neurosurgeryintensive carecommunicationproceduralunfractionated heparin
WAmental health2018-09-19

Inquest into the Death of Wlodzimierz DUDEK

69y · Male·bronchopneumonia and hypoxic brain injury following aspiration of food (choking)

… choked on bread while eating breakfast unattended and suffered a cardiac arrest. Despite resuscitation and ICU admission, he died from bronchopneumonia and hypoxic brain injury. The coroner found the death was accident…

psychiatryemergency medicinecommunicationsystem
13458

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