Inquest into the death of Janelle Pamkal

35y · Female·aortic dissection with associated acute aortitis

A 35-year-old Aboriginal woman with schizoaffective disorder presenting with acute psychosis and chest pain was appropriately referred for psychiatric assessment and retrieval. CareFlight transport was timely and the receiving ED team initiated appropriate chest pain investigation including troponin, ECG, CTPA and D-dimer testing. However, she suffered a rare Type A aortic dissection with acute aortitis, an extremely uncommon diagnosis in young women without typical risk factors. The coroner found that despite appropriate sequential diagnostic reasoning, the dissection extended and caused cardiac arrest before diagnosis could be made. Even if diagnosed that evening, transfer to Adelaide for cardiothoracic surgery (unavailable in Darwin) would not have been achievable in time. The coroner determined the death was unavoidable despite best efforts by all treating teams.