Coronial

180 results for anticoagulation

TAScommunity2016-09-12

Coroner's Finding: Broomhall, Tyler John

23y · Male·intra-cerebral haemorrhage following methylamphetamine use

Tyler John Broomhall, a 23-year-old factory worker, died from intracranial haemorrhage following methylamphetamine use during a football match. He had suffered a prior unreported work-related head injury 4-6 weeks earlie…

emergency medicineintensive carediagnosticdelaymethamphetamine
VIChospital2013-06-17

Finding into death of Trevor Edward Hammond

72y · Male·ischaemic heart disease secondary to coronary artery disease

…rsued a pulmonary embolus diagnosis based on pleuritic-sounding pain and positive d-dimer, commencing anticoagulation. CTPA was negative and he was discharged with plans for outpatient cardiology review. He died at home…

emergency medicinecardiologydiagnosticdelaydigoxin
ACThospital2010-04-30

Inquest Into The Death Of Meg Malaika

39y · Female·heart failure connected to a massive pulmonary embolus as a result of deep vein …

…aps in medication reconciliation and documentation. Key clinical lessons include: ensure prophylactic anticoagulation is clearly documented in post-operative patients with risk factors, maintain integrated medication re…

emergency medicinegeneral surgerymedicationcommunicationheparin
VICcommunity2024-12-18

Finding into death of Kevin John Harris

38y · Male·Pulmonary thromboembolism in the setting of deep vein thrombosis

Kevin Harris, a 38-year-old man with obesity, sustained a left tibial plateau fracture from a workplace fall on 27 December 2022. His general practitioner managed the injury conservatively with rest, ice, and anti-inflam…

general practiceorthopaedic surgerysystem
QLDhospital2025-08-11

Inquest into the death of John Reginald Wright

79y · Male·Complications of peripheral vascular disease with Type 2 Diabetes Mellitus, atri…

John Reginald Wright, a 79-year-old remand prisoner, died from complications of peripheral vascular disease with diabetes, atrial fibrillation, cardiomyopathy and delirium. He was transferred to Princess Alexandra Hospit…

vascular surgerygeneral medicineglicazide
SAhospital2001-11-08

Coroner's Finding: STEWART Margaret May

77y · Female·multi-organ failure due to massive transfusion-induced coagulopathy following re…

…hy after a retroperitoneal haemorrhage of unknown origin post-knee replacement surgery. While Fragmin anticoagulation was appropriately prescribed, the critical issue was inadequate fresh frozen plasma replacement durin…

surgeryvascular surgerycommunicationsystemdalteparin
QLDhospital2013-05-22

Thoresen, Cynthia

88y · Female·pulmonary thromboembolism due to fractured right femur due to a fall

… and malnutrition. Hospital staff provided appropriate, multidisciplinary care including prophylactic anticoagulation, but the patient deteriorated and died from pulmonary embolism. Clinical lessons: family carers requi…

orthopaedic surgeryemergency medicinedelaysystemmorphine
WAhospital2019-06-21

Inquest into the Death of Gerda Theresia DUNKEL

44y · Female·pulmonary thromboembolism in a woman with likely myeloproliferative neoplasm

…nd was anticoagulated. Five days later she developed bilateral leg DVT and pulmonary embolism despite anticoagulation, and died from catastrophic pulmonary embolism. Post-mortem identified an undiagnosed myeloproliferat…

general surgerybariatric surgerydiagnosticcommunicationheparin
VIChospital2022-01-20

Finding into death of Ann-Maree Manno

57y · Female·Pulmonary thromboembolism

Ann-Maree Manno, 57, died from pulmonary thromboembolism 8 days after laparoscopic gastric band surgery. She had significant risk factors: obesity (BMI 37.9), history of unprovoked DVT in 2007 and 2016, and recent surger…

bariatric surgeryanaesthesiacommunicationsystemheparin
VIChospital2014-01-21

Finding into death of Eddie Teck Chuan Lee

66y · Male·Intracerebral haemorrhage

A 66-year-old man with intracerebral haemorrhage and concurrent deep vein thrombosis died following an accidental tenfold heparin overdose. The patient received 20,000 units instead of 2,000 units due to a nurse misreadi…

neurosurgeryneurologymedicationsystemheparin
SAhospital2008-08-15

Coroner's Finding: EDWARDS Natasha Anne

31y · Female·right cerebellar cerebrovascular accident (cerebellar infarction with obstructiv…

… death. Expert evidence indicated 60-70% survival likelihood if condition recognized and treated with anticoagulation within 24 hours. Key failures: failure to follow up lumbar puncture results promptly on Saturday afte…

neurologygeneral medicinediagnosticdelaymetoclopramide
WA2022-08-05

Inquest into the Death of Michael James HARDIE

41y · Male·haemothorax due to ruptured thoracic aortic aneurysm in a man with Marfan syndro…

A 41-year-old man with Marfan syndrome and a thoracic aortic aneurysm managed conservatively with blood pressure medications died from aneurysm rupture while imprisoned. Methylamphetamine in his system significantly elev…

cardiologyvascular surgerycommunicationsystemmethamphetamine
QLDhospital2015-05-26

SM - Non-inquest findings

32y · Male·Pulmonary embolism originating from deep vein thrombosis in right calf

…on of oxygen desaturation could have raised suspicion for pulmonary embolism and prompted therapeutic anticoagulation rather than prophylactic doses, potentially changing outcome.

general surgeryanaesthesiadiagnosticcommunicationheparin
SAhospital2004-04-30

Coroner's Finding: YOUNG Iris Patricia

60y · Female·haemorrhagic shock and respiratory failure due to right-sided haemothorax compli…

A 60-year-old woman with metastatic breast cancer and COAD died from haemorrhagic shock due to right-sided haemothorax complicating thoracentesis. The procedure was appropriately performed to drain a pleural effusion on …

oncologyrespiratory medicinediagnosticcommunicationheparin
WAhospital2013-01-17

Inquest into the Death of Wendy May Aslett

60y · Female·Multiple organ failure following haemorrhage from penetration of the femoral art…

A 60-year-old woman died from multiple organ failure caused by uncontrolled bleeding from an arterial puncture sustained during coronary angiography. Although the procedure itself was uncomplicated and an Angio-Seal devi…

cardiologygeneral practicediagnosticcommunicationaspirin
NSWhospital2012-11-20

Channell & ivanoska decision

Female·Pulmonary thromboembolism due to deep vein thrombosis following lower leg fractu…

Two women aged 48 and 59 presented to Shellharbour Hospital ED with lower leg fractures sustained in falls. Both were treated conservatively with immobilization (splint and plaster back slab) and discharged home without …

emergency medicineorthopaedic surgerydiagnosticsystem
QLDaged care2024-12-10

Non-inquest findings into the death of Mr O.

79y · Male·Respiratory failure due to haemothorax and hospital-acquired pneumonia due to mu…

A 79-year-old man with extensive comorbidities died following multiple falls in residential aged care. He was identified as high falls risk on admission but experienced inadequate falls prevention after a second fall on …

geriatric medicineemergency medicinediagnosticmedicationaspirin
NThospital2008-10-29

Inquest into the death of Sandra McRae

57y · Female·acute pulmonary embolism

…clinicians. While no guarantee existed that prophylaxis would have prevented death, the coroner found anticoagulation should have been administered once haemodynamic stability and absence of bleeding were confirmed. The…

orthopaedic surgeryintensive carediagnosticsystem
WAcommunity2005-05

Inquest into the Death of Adam David McKay

31y · Male·Pulmonary thromboembolism arising from deep vein thrombosis

…ary testing (D-dimer or ultrasound) for DVT in December would likely have been diagnostic and allowed anticoagulation before fatal embolisation. Key clinical lessons: diagnostic criteria may inadequately weight risk fac…

general practiceemergency medicinediagnosticcommunication
QLDhospital2018-10-24

Statis, Joshua Ryan

12y · Male·Cardiac haemorrhage due to or as a consequence of congenital aortic stenosis (su…

Joshua Statis, a 12-year-old with complex congenital aortic stenosis, died 18 days after a redo Konno procedure and aortic valve replacement when a CardioCel patch to the right ventricular outflow tract (RVOT) ruptured, …

cardiothoracic surgerycardiologycommunicationdiagnosticwarfarin
189

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