Coronial

77 results for early septic shock

QLDhospital2018-08-20

RD - Non-inquest findings

64y · Male·Septic shock secondary to urosepsis (Pseudomonas and Stenotropomonas maltophilia…

…tropes, and ICU review at the first hospital could have changed the outcome. Key lessons: recognize sepsis early despite diagnostic uncertainty, act on objective vital sign trends, escalate to senior staff when patients…

emergency medicineintensive carediagnosticmedicationintravenous normal saline
TAShospital2021-08-20

Coroner's Finding: LA

67y · Male·acute gastrointestinal haemorrhage complicating peptic ulcer of the duodenum wit…

…erative complications from laparoscopic Hartmann's procedure for diverticulitis. Key clinical lessons: (1) Early persistent elevation of C-reactive protein post-colorectal surgery is a recognized marker of anastomotic l…

general surgeryintensive carediagnosticmedicationrabeprazole
SAhospital2006-05-12

Coroner's Finding: MARTIN Kirsten Lee

24y · Female·multi organ failure due to meningococcal septicaemia

… hours later with characteristic petechial rash, admitted to ICU, but died within hours from meningococcal septicaemia. Critical failures: over-reliance on absence of rash and meningeal signs to exclude meningococcaemia;…

emergency medicineinfectious diseasesdiagnosticcommunication
VIChospital2017-07-18

Finding into death of Lynsie Maree Everett

36y · Female·Complications of pneumonia and pulmonary emphysema with bullae formation; respir…

A 36-year-old woman with congenital chest wall abnormality, scoliosis, and difficult intubation history presented to a rural hospital with community-acquired pneumonia and sepsis. She had multiple 'red flag' indicators o…

emergency medicineinfectious diseasesdiagnosticsystemsalbutamol
VICaged care2022-06-17

Finding into death of Brent Andrew Newman

58y · Male·Pneumonia and urosepsis

Brent Newman, a 58-year-old man with Down syndrome and early-onset dementia, died from pneumonia and urosepsis following inadequate care at an aged care facility. His …

geriatric medicinegeneral practicecommunicationsystemcefalexin
SAhospital2000-07-21

Coroner's Finding: HOWIESON Julie Ann

43y · Female·sepsis secondary to extensive acute peritonitis following perforation of small b…

43-year-old woman died from sepsis and necrotising fasciitis following small bowel perforation during laparoscopic tubal ligation. She was at high risk due to previous abdominal surgeries and adhesions. A 4-5mm perforati…

gynaecologyanaesthesiadiagnosticdelay
QLDcommunity2020-04-17

Russo, Matthew Anthony

37y · Male·Cardiac failure due to sepsis due to bilateral bronchopneumonia

Matthew Russo, a 37-year-old man, died from sepsis and cardiac failure secondary to bilateral bronchopneumonia within 18 hours of consultation with Dr M.. The coroner found the medical treatment inadequate and inappropri…

general practicerespiratory medicinediagnosticcommunicationamoxicillin
QLDhospital2016-11-14

Ms H - non-inquest findings

23y · Female·Necrotising retroperitoneal fasciitis due to acute perforated gangrenous appendi…

…al intervention. Key clinical lessons: presumption of capacity may not apply when guardianship is unknown; early consideration of acute appendicitis in presentations with fever, tachycardia, right lower quadrant pain an…

emergency medicinesurgerysystemdiagnosticparacetamol
VIChospital2025-08-04

Finding into death of Winifred Jean Carpenter

82y · Female·Peritonitis due to leakage of bowel contents from bowel anastomosis following el…

…egardless of format; ensure junior staff communicate critical decisions verbally to seniors and document clearly; implement standardized escalation policies; and identify nutritional risk early post-operatively.

general surgerycolorectal surgerydiagnosticcommunication
NSWhospital2018-05-30

Inquest into the death of Marcia Clark

83y · Female·Combined effects of severe malnutrition and infection (septicaemia secondary to …

Mrs Clark, 83, died from severe malnutrition and infection including septicaemia from an infected sacral pressure ulcer that had existed for 7 months. She was admitted to hospital in…

geriatric medicinegeneral practicediagnosticcommunicationolanzapine
NSWhospital2024-05-10

Inquest into the death of Finlay Browne

16y · Male·mid-gut volvulus and bowel obstruction, leading to ischaemic bowel and related c…

Finlay Browne, a 16-year-old with Down syndrome, presented to Bathurst Base Hospital on 30 September 2016 with acute abdominal pain and vomiting. Despite clear clinical signs—including a lactate of 7.2 mmol/L (grossly ab…

emergency medicinesurgerydiagnosticcommunication
WAhospital2026-03-26

Inquest into the Death of Sandipan DHAR

1y · Male·Complications of acute lymphoblastic leukaemia

Sandipan Dhar, 21 months old, died from undiagnosed acute lymphoblastic leukaemia (ALL) complicated by sepsis and pneumonia on 24 March 2024. After three weeks of intermittent fever, he attended his GP three times and wa…

emergency medicinegeneral practicediagnosticcommunicationparacetamol
NSWhospital2021-11-09

Inquest into the death of Caitlin CRUZ

3y · Female·complications of Influenza B viral infection

…e ward at 8:39pm showed widespread ST elevation consistent with pericarditis but was interpreted as benign early repolarisation by a junior registrar without senior review. No cardiology consultation occurred. Caitlin h…

emergency medicinepaediatricscommunicationdiagnosticmidazolam
NSWhospital2019-07-29

Inquest into the death of Naomi Williams

27y · Female·Septicaemia secondary to Neisseria meningitides infection

Naomi Williams, a 27-year-old Wiradjuri woman, died from meningococcal septicaemia on 1 January 2016. She presented to Tumut Hospital in the early hours with generalised aches and pain…

emergency medicinegeneral practicediagnosticcommunicationparacetamol
WAhospital2018-06-14

Inquest into the Death of Anne RZEPCZYNSKI

59y · Female·complications of intra-abdominal sepsis, including multi-organ failure and bowel…

59-year-old woman died from intra-abdominal sepsis, multi-organ failure and bowel perforation following median hepatectomy for cholangiocarcinoma. Key clinical issues included: surgical delays of 20 days between stent in…

general surgeryintensive carediagnosticdelayantibiotics
NSWcustodial setting (correctional facility) with death at hospital2025-07-23

Inquest into the death of James Cunneen

60y · Male·Ischaemic heart disease with a bleeding duodenal ulcer being a significant contr…

…e to severe understaffing, with one GP managing a population that contractually required multiple doctors. Early hospitalisation on multiple occasions could likely have prevented death.

general practiceinfectious diseasesdiagnosticmedicationpantoprazole
WAhospital2004-06-17

Inquest into the Death of Edmiston

41y · Female·Peritonitis following surgical procedure to the urinary bladder, due to infected…

Cheryl Lee Edmiston, a healthy 41-year-old woman, died of peritonitis and sepsis following minor bladder procedures (cystoscopy, hydrodilatation, and biopsy) at Joondalup Health Campus on 14 February 2003. The biopsies w…

urologygeneral surgerydiagnosticmedicationamoxicillin

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