145 results for “reflux disease”
44y · Male·intravenous injection of foreign debris (crushed tablets) associated with chroni…
Timothy Wellington, a 44-year-old man with longstanding opioid and polysubstance use disorder, died from acute pulmonary hypertension caused by intravenous injection of foreign debris (crushed tablets). He had been presc…
43y · Male·methadone toxicity
…nce-based addiction treatment in custodial settings, particularly for vulnerable individuals with cardiac disease who are at heightened risk of fatal opioid toxicity. The finding highlights systemic delays in accessing …
47y · Male·Sudden cardiac death in association with COVID-19 infection
Alen Imbrisak, a 47-year-old man incarcerated at Junee Correctional Centre, died on 26 January 2022 from sudden cardiac death in association with COVID-19 infection. He tested positive on 25 January 2022 during a centre-…
51y · Female·Mixed drug toxicity
A 51-year-old woman with longstanding treatment-resistant depression, chronic pain, and suicidal ideation died from mixed drug toxicity. She intentionally overdosed on multiple medications including benzodiazepines, anti…
45y · Male·choking on food
Richard Mann, a 45-year-old man with intellectual disability and psychiatric illness residing in an institutional setting (Strathmont Centre infirmary), died from choking on food. Critical failures in observation and mon…
49y · Male·complications of non-small cell carcinoma of the lung
…al Centre after 5 weeks of incarceration. He had complex medical needs including HIV, peripheral vascular disease, and depression. The coroner found the transfer of care from community to custody was below best practice…
84y · Male·Complications of large right subdural haematoma
An elderly man with cognitive impairment and multiple comorbidities fell out of bed at an aged care facility while an assistant in nursing (AIN) was absent obtaining equipment. The AIN had raised the bed to facilitate us…
57y · Male·Neck compression and hanging
A 57-year-old man with schizophrenia and schizoaffective disorder died by hanging in prison on 4 August 2024. He had been receiving antipsychotic treatment via injection (paliperidone) but ceased antipsychotic medication…
67y · Female·perforated gastric ulcer; morphine toxicity also made a significant contribution
Mrs Lillian Shaw, a 67-year-old obese woman with a history of NSAID use, presented with vomiting and abdominal pain over 36 hours. A GP visited three times without performing adequate physical examination, failed to insp…
42y · Female·Hypoxic brain injury due to choking on food, with Cornelia de Lange Syndrome con…
Bridie Gilligan, 42, with Cornelia de Lange Syndrome, intellectual disability, and dysphagia, choked on a Yumbo burger in her Supported Independent Living accommodation on 29 April 2021, suffering fatal hypoxic brain inj…
79y · Female·pneumonia in the setting of acute peritonitis due to perforated stomach (operate…
Mrs Thelma Katherine Holt, a 79-year-old woman with multiple comorbidities including obesity, vascular disease, hypertension, and prior Nissen fundoplication, underwent placement of a second intragastric balloon on 1…
80y · Male·aspiration pneumonia
Ernest Charles Willetts, 80, died from aspiration pneumonia following an appendectomy. On hospital day 3, he developed coffee-ground vomitus indicating gastrointestinal bleeding. A gastroscopy was performed that afternoo…
76y · Female·hospital acquired pneumonia, multiple organ dysfunction and small bowel obstruct…
Mrs Cook, a 76-year-old woman, died in January 2010 from hospital-acquired pneumonia, multiple organ dysfunction, and small bowel obstruction. She was admitted to a rural hospital with acute renal failure and dangerously…
50y · Male·Hypoxic-ischaemic encephalopathy secondary to choking on food bolus
A 50-year-old man with acquired brain injury and intellectual disability died from hypoxic-ischaemic encephalopathy following aspiration of a food bolus during lunch at his disability care residence. The carer appropriat…
41y · Female·acute myocardial infarction
…perienced a myocardial infarction (AMI) by the time of presentation but was discharged with a diagnosis of reflux. Critical failures included: (1) failure to recognise diagnostic ECG changes between two tracings taken on…
34y · Male·Cardiac tamponade due to hemopericardium from acute aortic dissection of the asc…
A 34-year-old previously healthy man presented to the ED with sudden-onset central chest pain. He was discharged with a diagnosis of GORD after negative troponin and symptomatic relief with antacids. A chest X-ray showed…
79y · Male·complications of peritonitis
A 79-year-old man with multiple comorbidities presented with a perforated bowel requiring emergency Hartmann's procedure. The operating surgeon, Dr L.-Ming Schmidt, made a catastrophic surgical error by exteriorising the…
85y · Female·sepsis, with aspiration pneumonitis being an antecedent cause. Iatrogenic injury…
Lorraine Barnes, an 85-year-old woman admitted to Wollongong Private Hospital for convalescence, died from sepsis with aspiration pneumonitis following iatrogenic lung injury. She developed severe malnutrition and electr…
56y · Male·Hanging
Chao Liang Mai, a 56-year-old remanded prisoner with documented psychiatric history and previous suicide/self-harm risk flags, died by hanging in a prison cell on 27 November 2018. Critical systemic failures included: (1…
67y · Female·Sepsis as a result of gastric perforation
Margaret Pegum, aged 67, died from sepsis following gastric perforation after an intragastric balloon (IGB) procedure for weight loss. She had undergone fundoplication for hiatus hernia in 2012. Despite prior gastric sur…
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