Coronial

191 results for acute kidney injury

VIChospital2014-06-20

Finding into death of Rosalie Anne King

29y · Female·Bronchopneumonia in a woman with brain injury

…en days after transfer to the trauma ward, she experienced sudden respiratory arrest causing hypoxic brain injury. Despite resuscitation, she suffered profound neurological injury with poor prognosis and was transferred …

trauma surgeryintensive care
VIChospital2022-03-28

Finding into death of FJ L

24y · Male·Mixed drug toxicity (25C-NBOME, 4-fluoroamphetamine, LSD, MDMA, cocaine, ketamin…

A 24-year-old previously healthy male died from mixed drug toxicity after ingesting multiple substances (25C-NBOME, 4-fluoroamphetamine, LSD, MDMA, cocaine, ketamine) at a music festival. He presented to the Alfred Hospi…

emergency medicineintensive care25c-nbome
ACThospital2023-01-30

Inquest into the Death of Maarouf El-Cheikh

57y · Male·streptococcus pneumonia septicaemia due to splenectomy

…al care deficiencies: inadequate urine output monitoring (no urinary catheter despite critical illness and acute kidney injury); delayed and sub-optimal antibiotic dosing and timing; failure to place arterial line for c…

emergency medicineintensive carediagnosticmedicationceftriaxone
TAShospital2023-10-11

Coroner's Finding: Jones, Emily Margaret Rose

82y · Female·traumatic closed head injury (subdural haematoma) resulting from a fall from sta…

…spondence in accessible locations. Falls prevention strategies were appropriate, though reassessment after acute arrhythmia on 13 November was not undertaken.

cardiologyemergency medicinemedicationcommunicationmetoprolol
QLD2016-07-06

Mickelo, Garnett Allan

48y · Male·myocardial infarction due to coronary atherosclerosis (medically treated)

…egrettable, did not causally contribute to the death, which was predictable given his extensive myocardial injury. Systemic improvements have since been implemented at WCC for discharge medication reconciliation, chest p…

cardiologycardiothoracic surgerymedicationcommunicationisosorbide mononitrate
VIC2022-02-10

Finding into death of Elaine Betty Sime

72y · Female·multi-organ failure secondary to poly-trauma and likely bee-sting related toxidr…

Elaine Betty Sime, a 72-year-old fit and healthy woman, died from multi-organ failure following poly-trauma and bee sting toxidrome after a tree fell on her during a walk. The tree at Ruffey Lake Park Trail failed due to…

emergency medicinetrauma surgerysystem
WAhospital2023-01-11

Inquest into the Death of Colin Albert WINTER

71y · Male·End-stage chronic obstructive pulmonary disease and atherosclerotic heart diseas…

Colin Albert Winter, a 71-year-old prisoner who died from end-stage COPD and atherosclerotic heart disease, received comprehensive medical care during 33 years of incarceration at Casuarina Prison. Key clinical lessons i…

respiratory medicinecardiologycommunicationsystem
VIChospital2021-12-10

Finding into death of Ronald Jelbert

90y · Male·Sepsis in the setting of cachexia in a man with multiple comorbidities

Ronald Jelbert, a 90-year-old man with moderate intellectual disability living in a disability group home, was admitted to hospital on 21 December 2019 with sepsis suspected secondary to urinary tract infection, colonic …

emergency medicinegeneral medicine
QLDaged care2019-07-12

Fenech, George - Non-inquest findings

89y · Male·Congestive heart failure due to or as a consequence of ischaemic cardiomyopathy

…pathy complicated by congestive heart failure after a fall at a nursing home. He suffered a cervical spine injury (C1-C2 subluxation) and head laceration during an unwitnessed fall at 2:45am on 9 November 2017. Clinical …

geriatric medicineemergency medicinecommunicationdelaywarfarin
VICaged care2025-05-22

Finding into death of Veronica Lesley Roberts

75y · Female·Ischaemic heart disease in the setting of unstable type 2 diabetes mellitus and …

Veronica Roberts, 75, died from ischaemic heart disease complicated by unstable diabetes and a medication error. On 4 October 2020, her insulin dose was increased to 20 units daily, but due to Electronic Medical Record (…

geriatric medicinegeneral medicinemedicationsystemglargine insulin
VICaged care2023-03-22

Finding into death of S M

91y · Male·Complications of cerebrovascular and ischaemic heart disease in a man post anaph…

… not verify allergies before administration. The patient developed severe DRESS syndrome with anaphylaxis, acute kidney injury, liver dysfunction, and elevated inflammatory markers. He subsequently suffered a cerebrovas…

geriatric medicinegeneral practicediagnosticmedicationdiltiazem
VICmental health2025-02-27

Finding into death of Judith Mary Pollard

73y · Female·Complications of lipoid pneumonia following the ingestion of shampoo, conditione…

…ve mental health history, was voluntarily admitted to Shepparton Private Hospital on 1 June 2023 following acute depression and paranoia. Despite her family informing staff of her previous suicide attempt by hanging in …

psychiatryemergency medicinesystemcommunicationamitriptyline
VIChome2019-11-28

Finding into death of Sonya Szala

49y · Female·Anorexia

Sonya Szala, 49, died from anorexia nervosa after suffering severe metabolic derangement and extreme emaciation. She became a recluse following her mother's death in 2016 and progressively deteriorated both physically an…

emergency medicinepsychiatrydelaybisacodyl
WAhospital2021-03-26

Inquest into the Death of Cyril CHURCHILL

68y · Male·surgical complications following laparoscopic cholecystectomy for cholecystitis,…

…d man with multiple comorbidities, died from surgical complications after laparoscopic cholecystectomy for acute cholecystitis. Postoperatively, he developed profound hypotension. The treating team disagreed on whether …

general surgeryanaesthesiadiagnosticcommunication
VICaged care2016-02-08

Finding into death of Leslie Frederick Alexander

77y · Male·Subarachnoid and subdural haemorrhage post head trauma secondary to a fall

… on 29 March and again on 30 March 2015, striking his head. Initial assessment by a locum GP found no head injury evidence and neurological observations were ceased. On 30 March morning, Mr Alexander deteriorated with co…

general practiceemergency medicinediagnosticcommunication
VIChospital2022-02-22

Finding into death of Matthew Lee Dongelmans

30y · Male·Complications of methylamphetamine toxicity

…ient and lack of escalation. However, the coroner concluded the delay likely did not prevent death, as the acute methylamphetamine toxicity and resulting multi-organ failure would have been difficult to reverse regardle…

emergency medicineintensive caredelaysystemmethamphetamine
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
VIChospital2018-10-18

Finding into death of Maxwell Norman Campbell

68y · Male·pulmonary thromboembolism in the setting of recent surgery

A 68-year-old man died from pulmonary thromboembolism following revisional gastric bypass surgery. He developed multiple post-operative complications including fever, elevated inflammatory markers, and a possible bowel p…

bariatric surgerygeneral surgeryheparin
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 …

…dence-based, may not account for individual anatomical variation; heightened vigilance for early ischaemic injury signs is warranted despite diagnostic difficulty in complex cardiac surgical patients.

cardiothoracic surgeryintensive caresystem
SAhospital2020-06-18

Coroner's Finding: THOMPSON Wayne Robert McInnes

33y · Male·Multi-organ failure due to sepsis on a background of severe ischaemic cardiomyop…

Wayne Robert McInnes Thompson, aged 33, died from multi-organ failure due to sepsis complicated by severe ischaemic cardiomyopathy. He had a complex medical history including viral myocarditis, previous intestinal resect…

cardiologyintensive carewarfarin
156710

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