18 results for “ultrasound guidance”
Female·Combination of liver failure, blood loss and shock following needle biopsy
…atients, reassured nursing staff despite their concerns. A cardiac arrest occurred at 2:35 PM. Emergency ultrasound showed active portal vein bleeding and massive intra-capsular hemorrhage. Emergency surgery 4 hours late…
74y · Female·Complications of carotid artery injury from central line insertion in the settin…
…ulti-organ failure and died. While arterial puncture is a recognised 6-9% complication of CVC insertion, ultrasound guidance—now considered gold standard—was used but not documented. Northern Health implemented comprehen…
43y · Male·Hypoxic brain injury secondary to haemopericardium and tamponade complicating ru…
…ration of the right ventricular outflow tract (RVOT), possibly from the drainage needle inserted without ultrasound guidance. Despite resuscitation and emergency transfer to a tertiary cardiac centre, he suffered irrever…
<1y · Male·Hypoxic-ischemic encephalopathy and massive subgaleal haemorrhage, both associat…
…successful vacuum extraction. Clinical failures included: inadequate determination of fetal position (no ultrasound used despite disagreement between clinicians), incorrect placement of vacuum cup, unreasonably delayed c…
71y · Female·Ruptured abdominal aortic aneurysm, with coronary artery atherosclerosis contrib…
… becoming dismissive of the local doctor; (3) the retrieving doctor (Dr J.) performed an inadequate FAST ultrasound, over-relied on a negative result, and incorrectly prioritized sepsis as the working diagnosis; (4) crit…
Unknown·Philip Byrne: pulmonary thromboembolism due to right calf deep vein thrombosis; …
…th right calf pain in February 2012; two GPs excluded DVT on clinical examination alone without ordering ultrasound despite his history of previous DVT. Mrs Weaver presented with left calf pain, chest pain and palpitatio…
28y · Female·3,4-methylenedioxy-N-methylamphetamine (MDMA) and ketamine toxicity
…s at music events to enable informed decision-making about drug potency and composition; and (2) improved guidance for music event organisers on implementing evidence-based harm reduction principles. The coroner emphasis…
<1y · Male·subgaleal haematoma and subarachnoid haemorrhage complicating a prolonged labour
…al position must be definitively established before instrumental delivery using clinical examination and ultrasound if uncertain; unaccredited registrars require direct supervisor presence; slow labour progression should…
68y · Male·surgical complications following laparoscopic cholecystectomy for cholecystitis,…
Cyril Churchill, a 68-year-old man with multiple comorbidities, died from surgical complications after laparoscopic cholecystectomy for acute cholecystitis. Postoperatively, he developed profound hypotension. The treatin…
81y · Female·left haemothorax and mediastinal haemorrhage from the insertion site of the perm…
…in insertion. Implementation of cardiac-specific observation scoring systems, amended clinical pathways, ultrasound-guided vein puncture protocols, and clearer after-hours access procedures have since been instituted.
29y · Male·Pulmonary thromboembolism secondary to deep venous thrombosis
…se and that cessation did not cause or contribute to death. However, the case highlights gaps in clinical guidance: defining 'immobility' for VTE assessment in psychiatric patients and clarifying when oral anticoagulants…
72y · Male·acute gangrene of colon with probable perforation along with bowel obstruction a…
Giovanni Bertoncini, a 72-year-old man with diabetes and cardiac disease, presented to Sir Charles Gairdner Hospital on Christmas Day 2002 with acute abdominal pain and vomiting. Over two days, his condition deteriorated…
<1y · Female·Neonatal pneumonia, meconium aspiration and chorioamnionitis secondary to prolon…
Baby E died at home one day after birth at 40+ weeks gestation following a prolonged labour in a hired plastic birthing pool. The mother had no antenatal care, no midwifery support, and her Group B Streptococcus status w…
35y · Female·Pulmonary thromboembolus and pulmonary infarction
A 35-year-old woman at 11 weeks gestation presented to Royal Women's Hospital Emergency Care on 3 September 2012 with chest and rib pain following severe vomiting. Dr M., a junior resident working alone overnight, assess…
38y · Female·Pulmonary Thromboembolism
Kellie Anne Keogh, 38, died from pulmonary thromboembolism on 10 November 2008 after complex pancreatic surgery. She had nephrotic syndrome with decreased anti-thrombin III levels, initially presenting with suspected DVT…
12y · Female·Hypoxic ischaemic encephalopathy complicating an aortic root abscess (operated) …
A 12-year-old Aboriginal girl with a bicuspid aortic valve and autism spectrum disorder presented with a week of fever and non-specific symptoms (cough, vomiting, abdominal pain, chest pain) to a rural hospital. Despite …
<1y · Female·brain death complicating head and neck injury
A five-month-old girl died from catastrophic brain injuries caused by violent shaking on 20 May 2019. Medical evidence established she was shaken by an adult on at least two occasions: once around 6 May 2019 (evidenced b…
17y · Male·Hypoxic Ischaemic Encephalopathy Complicating Anaphylaxis
James Tsindos, a 17-year-old with known nut allergy and mild asthma, experienced anaphylaxis after inadvertently ingesting cashews in a vegan restaurant meal on 27 May 2021. Ambulance paramedics administered two doses of…
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