Coroner's Finding: Brown, Sandra Anne
54y · Female·hypothermia, likely related to drug toxicity
Sandra Anne Brown, a 54-year-old woman with multiple chronic conditions including COPD, diabetes, bipolar disord…
43 results for “acidosis (metabolic and respiratory)”
54y · Female·hypothermia, likely related to drug toxicity
Sandra Anne Brown, a 54-year-old woman with multiple chronic conditions including COPD, diabetes, bipolar disord…
82y · Female·Hyperkalaemia due to acute renal failure on a background of end stage pulmonary …
An 82-year-old woman with terminal pulmonary fibrosis and chronic respiratory failure presented with chest pain, hyperkalaemia and metabolic acidosis. She became com…
0y · Female·Methylamphetamine toxicity
…gement was appropriate—the baby showed mild respiratory distress managed with CPAP, had normal vital signs, and was transferred to special care nursery for monitoring. The acute deterioration at 5 a.m. with respiratory …
68y · Male·community-acquired pneumonia in a setting of advanced centriacinar emphysema, al…
…red pneumonia complicated by asplenia (absent splenic function), chronic liver disease from alcohol misuse, and severe malnutrition. He presented with syncopal episodes, cachexia, and metabolic derangement. Critical cli…
6y · Male·respiratory failure due to pneumonia
… congenital conditions including cerebral palsy, epilepsy, severe developmental delay, aspiration syndrome, and microcephaly. He was in state care under a Protection Order. After admission with viral pneumonia and incre…
64y · Male·Complications of metformin toxicity on a background of undiagnosed renal impairm…
…imprisoned at Junee Correctional Centre, died from metformin toxicity complicated by acute renal impairment and severe lactic acidosis. His renal function deteriorated in the three to four weeks before 2 January 2019, d…
0y · Male·complications of extreme prematurity in the setting of precipitant premature bre…
…nce concluded the morphine was unlikely to have contributed to death, as Jordan was mechanically ventilated and his deterioration preceded the morphine administration. Jordan's death resulted from complications of extre…
38y · Female·peritonitis with septic shock secondary to perforation of the gastrointestinal t…
…ratory causes while missing abdominal clues (elevated pulse, respiratory rate, low bicarbonate indicating acidosis). (2) The patient was inappropriately discharged at 3:30am without diagnosis while clearly unwell, to a f…
57y · Male·Multiple Organ Failure and Intra-Abdominal Haemorrhage following Cholecystectomy
…roscopic cholecystectomy at a regional hospital. The procedure was converted to open due to dense adhesions and obesity. Post-operatively, he developed progressive hypoxia and signs of acute renal failure within hours. …
0y · Male·Hypovolemic shock, metabolic acidosis and coagulopathy in association with subga…
Owen Appleby, born at Portland Hospital after labour induction, developed hypovolemic shock and died at Warrnambool Hospital 17 hours afte…
33y · Male·hypoxic-ischaemic encephalopathy due to hanging with resuscitation
…ention. He was released from prison in December 2021 with parole conditions including electronic monitoring and curfew. Following relationship difficulties, arrest of his girlfriend, and a miscarriage, he experienced ac…
2y · Male·Group A beta Haemolytic Streptococcal septicaemia (invasive Group A Streptococca…
…e third visit; failure to repeat vital signs within one hour to confirm the tachycardia; failure to examine and reassess after petechial rash appeared; and not taking baseline blood pressure until 8pm. Although antibiot…
Female·Combination of liver failure, blood loss and shock following needle biopsy
…nfant, died from hemorrhage following a liver biopsy at Monash Medical Centre. She had persistent jaundice, and biopsy was undertaken to investigate potential biliary atresia. Post-operatively, nursing staff could not o…
13y · Female·hypoxic ischaemic encephalopathy secondary to gamma hydroxybutyrate toxicity
…ly naive to GHB's effects. She was resuscitated after cardiac arrest but suffered irreversible brain injury and died two days later. The coroner found no clinical failures by emergency responders or hospital staff, and …
2y · Male·Hyaline membrane disease and pneumonia in the setting of pneumothorax
…ted with respiratory distress at 11 hours of life. A capillary blood gas at 1:14pm showed mixed respiratory and metabolic acidosis indicating decompensation, but this was not recognized or escalated in the medical notes…
2y · Male·Perinatal asphyxia leading to cerebral anoxia and subsequent multi-organ failure
Sebastian Hewitt, born at 36 weeks gestation following maternal ante-partum haemorrhage and abnormal CTG traces, died from perinatal asphyxia leading to cerebral anoxia and multi-organ failure at 3 d…
24y · Male·Multiple organ failure due to or as a consequence of severe thermal burns
…esthetic machine rather than modern ventilator), lack of monitoring equipment, limited laboratory capacity, and inability to manage complex burns; (3) delayed recognition of abdominal compartment syndrome due to insuffi…
5y · Unknown·Aspiration pneumonia complicating a gastrointestinal illness in a child with cer…
…ld with severe cerebral palsy (GMFCS level 5), genetic disability (CACNA1A deletion), intractable epilepsy, and aspiration risk who died from aspiration pneumonia following a gastrointestinal illness. He was exclusively…
24y · Male·Mixed drug toxicity (25C-NBOME, 4-fluoroamphetamine, LSD, MDMA, cocaine, ketamin…
…usic festival. He presented to the Alfred Hospital ED with seizures, abnormal cardiac rhythm, hyperthermia, and rapidly deteriorated with serotonin syndrome features, multiorgan failure, and disseminated intravascular c…
0y · Female·Perinatal asphyxia
…different antenatal care including diabetes management, glucose monitoring, possible additional ultrasound, and continuous CTG monitoring during labour, likely changing labour management decisions. However, an expert ob…
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