Coronial

36 results for CPR administration

VICaged care2022-12-09

Finding into death of Blake Edwards

33y · Male·Ventricular arrhythmia associated with cardiomegaly

…ve approximately 30 minutes after being given yoghurt with his medications and could not be revived despite CPR. Autopsy confirmed cardiomegaly with left ventricular dilatation as the underlying cause. His pacemaker was…

cardiologypathologyoxycodone
VIC2014-03-06

Finding into death of Geoffrey Ashton

78y · Male·Ischemic heart disease

…ce station foyer; his second collapse occurred while in ventricular fibrillation. Critical delays occurred: CPR commenced only 5 minutes 49 seconds after collapse, and an automated external defibrillator (AED), though p…

cardiologypathologydelayprocedural
WApolice custody_and_home

Inquest into the Death of Desmond Richard KICKETT

34y · Male·multiple organ failure following cardiorespiratory arrest in a man with focal co…

…propriately used minimal restraint, placed him in recovery position, monitored him regularly, and initiated CPR when his condition deteriorated. The coroner found no police culpability. Clinical lessons include: recogni…

emergency medicinecardiologymethamphetamine
SAcommunity2010-04-01

Coroner's Finding: HALLORAN James Gordon

52y · Male·hypoxic-ischaemic encephalopathy due to cardiac arrest due to unknown aetiology

…vices by approximately 9 minutes, initially calling other doctors instead. When ambulance arrived at 18:07, CPR had only just begun and was of poor quality. Earlier paramedic involvement could have provided immediate re…

emergency medicineintensive caredelaycommunication
NSWhospital2019-12-20

Inquest into the death of Blair DALTON

35y · Female·hypoxic brain injury, with strangulation being an antecedent cause

… of warning signs in domestic relationships (prior police contact, documented tension), importance of early CPR initiation by bystanders and first responders, and appropriate ICU management of hypoxic-ischaemic brain in…

emergency medicineintensive care
VICaged care2010-05-19

Finding into death of Beatrice Ivy Brown

80y · Female·Acute upper airway obstruction secondary to aspiration of food bolus

…ff rarely encounter medical emergencies and require comprehensive training in emergency response, including CPR technique and when to continue resuscitation; (4) communication failures during emergencies—including failu…

geriatric medicineemergency medicinecommunicationsystem
VIC2011-04-03

Finding into death of Gary Witcombe

60y · Male·Neck injury, specifically fracture of the odontoid peg of the second cervical ve…

…y party. The injury caused immediate loss of consciousness and respiratory arrest. Despite prompt bystander CPR and paramedic resuscitation, he could not be revived. The coroner found insufficient evidence to determine …

emergency medicineparamedicinealcohol
SA2019-05-09

Coroner's Finding: PIKE Lucas Adam

43y · Male·morphine (heroin) toxicity

…an Dr K.'s daughter (also present), likely entering cardiac arrest shortly after injection. Dr K. initiated CPR upon discovering the collapsed patients but Pike could not be resuscitated. The coroner found no criticism …

general practiceemergency medicineheroin
WAhome2022-12-08

Inquest into the Death of Child B (Name Subject to Suppression Order)

3y · Male·Hypoxic ischaemic encephalopathy complicating hypoglycaemia with shock and statu…

…te care and had an emergency management plan for adrenal crisis requiring intramuscular hydrocortisone administration. His foster carer received only one-off training in 2018 on emergency hydrocortisone administration an…

endocrinologypaediatricssystemdelayhydrocortisone
NTcommunity2017-06-29

Inquest into the death of John Munkara

44y · Male·coronary artery disease superimposed upon chronic obstructive pulmonary disease …

…uest or alert paramedics, delaying ambulance response by two hours. Police lacked facemasks in vehicles for CPR. Importantly, in May 2015, Munkara had been admitted under the Alcohol Mandatory Treatment Act but was unla…

emergency medicineparamedicinecommunicationsystemalcohol
VIChospital2026-01-23

Finding into death of Trang Thi Thu Le

28y · Female·3,4-methylenedioxy-N-methylamphetamine (MDMA) and ketamine toxicity

Trang Thi Thu Le, 28, died on her birthday from MDMA and ketamine toxicity after attending an electronic dance music event at John Cain Arena. She collapsed after consuming drugs purchased from an unknown source within t…

emergency medicineintensive caresystemMDMA
NSWhospital2015-10-28

Inquest into the death of Michael NELSON

62y · Male·multiple co-morbidities including dementia, Parkinson's disease, undernourishmen…

…r Nelson developed respiratory depression and initial respiratory arrest, though he resumed breathing after CPR was ceased. He died approximately 4 hours later. The coroner found the IV midazolam was unusual and unpredi…

emergency medicineneurologymedicationcommunicationmidazolam
SAhospital2020-11-03

Coroner's Finding: WHISKEY Louise Kitty

51y · Female·community acquired pneumonia

…g noradrenaline delivery when her blood pressure was critically low (60 mmHg systolic). Despite manual administration resumption and maximal vasopressor support, she arrested at 7:06 am on 7 September. A review panel con…

intensive carepsychiatrysystemnoradrenaline
NSWhospital2022-10-26

Inquest into death of Lucas PEYRET

21y · Male·Hypoxic brain injury arising from severe anaphylactic shock due to administratio…

…aparoscopic appendicectomy. Surgery was routine and uneventful. Upon emergence from anaesthesia, after administration of Sugammadex (neuromuscular reversal agent), Lucas developed severe anaphylactic shock with bronchosp…

surgeryanaesthesiasugammadex
SA2006-11-16

Coroner's Finding: HARKIN Leonard Norman

51y · Male·ischaemic heart disease

…cers, was directed to walk to the medical centre, and collapsed shortly after arrival. Nurse Long initiated CPR appropriately and paramedics continued resuscitation efforts without success. Prior cardiac investigations …

cardiologyemergency medicineproceduraldelaymirtazapine
TAS2021-05-20

Coroner's Finding: Jones, Nathan John

36y · Male·Multiple organ failure and hypoxic encephalopathy due to cardiac arrest from inj…

… injection, he developed burning sensation and itching with erythema, collapsed in the shower, and required CPR. Despite paramedic resuscitation and intensive hospital care including ICU admission, he suffered progressi…

emergency medicineintensive caremethamphetamine
VICmental health2021-08-20

Finding into death of Marilyn

62y · Female·Unascertained

…e was found unresponsive at 7:30am after being given olanzapine 2.5mg at 1:00am the previous night. Despite CPR, she remained in asystole and died. No autopsy was performed due to family religious objections. The corone…

psychiatrygeriatric medicinefluoxetine
QLDhospital2013-04-16

Hornby, Geoffrey John

58y · Male·Respiratory failure due to or as a consequence of Chronic Obstructive Pulmonary …

…ping cardiac arrest on 17 March 2010. Critical delays occurred in recognising cardiac arrest and commencing CPR, with chest compressions not begun until approximately 1 minute 37-55 seconds after pulse loss. The coroner…

respiratory medicineemergency medicinecommunicationdelaysalbutamol
WA2015-03-27

Inquest into the Death of Ramaiah MAHENTHIRAN

50y · Male·coronary atherosclerosis

… He presented with chest pain shortly after arrival on 21 July and despite immediate medical care including CPR, adrenaline, and defibrillation, could not be resuscitated. The coroner found his medical supervision, trea…

emergency medicineoccupational and environmental healthglyceryl trinitrate
QLDcommunity2015-11-11

Child A - Non-inquest findings

8y · Female·Anoxia due to fresh water drowning

…cessful escape. Supervision was adequate but momentarily obstructed by a boat. Key clinical lessons: prompt CPR initiation by bystanders and emergency services, early telehealth consultation with paediatric intensive ca…

emergency medicineintensive caresystem

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