Coroner's Finding: Williams, Stewart

54y · Male·Hypoxic/ischaemic brain damage caused by blood loss and airway obstruction due to facial fractures from blunt force injury (assault); inadequate medical treatment contributed to death

A 54-year-old male was assaulted in a nightclub with a single punch causing orbital and facial fractures and posterior epistaxis. He presented to the Royal Hobart Hospital ED with active bleeding. Critical deficits in his emergency treatment included: failure to recognise hypovolaemic shock by 9.30am (four hours after arrival); lack of senior clinician involvement despite ongoing bleeding despite packing and initial interventions; inadequate fluid balance documentation leading to underestimation of blood loss (500ml initially unrecorded); delayed involvement of Oral Maxillofacial specialists; failure to implement posterior nasal packing until 12.27pm despite clinical deterioration; no definitive investigative plan for bleeding source; and premature discontinuation of the MET call at 12.17pm. Expert opinion concluded that with prompt posterior packing or angiography with arterial embolisation, the patient would likely have survived. Instead, he deteriorated into cardiac arrest requiring 97 minutes resuscitation, resulting in hypoxic-ischaemic brain injury from which he could not recover.