Patient Registration Form Page 2
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2ICU Admission Diagnosis Taxonomy
NON-OPERATIVE CONDITIONS
48.
Burns
Choose from this list if admission category is
49.
Other medical disease: __________
medical
POST-OPERATIVE CONDITIONS:
Cardiovascular / vascular:
Choose from this list if admission category is
1.
Cardiogenic shock
surgical
2.
Cardiac arrest
3.
Aortic aneurysm
Vascular / cardiovascular:
4.
Congestive heart failure
50.
Dissecting/ruptured aorta
5.
Peripheral vascular disease
51.
Peripheral vascular surgery (no bypass graft)
6.
Rhythm disturbance
52.
Valvular heart surgery/CABG
7.
Acute myocardial infarction
53.
Elective abdominal aneurysm repair
8.
Hypertension
54.
Peripheral artery bypass graft
9.
Other CV disease: __________
55.
Carotid endarterectomy
56.
Other CV disease: _____________
Respiratory:
10.
Parasitic pneumonia (ie.pneumocystis carinii)
Respiratory:
11.
Aspiration pneumonia
57.
Respiratory infection
12.
Respiratory neoplasm (inc. larynx, trachea)
58.
Lung neoplasm
13.
Respiratory arrest
59.
Respiratory neoplasm (mouth, sinus, larynx,
14.
Pulmonary edema (non-cardiogenic)
trachea)
15.
Bacterial / Viral pneumonia
60.
Other respiratory disease: __________
16.
Chronic obstructive pulmonary disease
17.
Pulmonary embolism
Gastrointestinal:
18.
Mechanical airway obstruction
61.
GI perforation/rupture
19.
Asthma
62.
GI inflammatory disease
20.
Other respiratory disease: ___________
63.
GI obstruction
64.
GI bleeding
Gastrointestinal:
65.
Pancreatitis
21.
Hepatic failure
66.
Liver transplant
22.
GI perforation/obstruction
67.
GI neoplasm
23.
GI bleeding due to varices
68.
GI cholecystitis / cholangitis
24.
GI inflammatory disease (ulcerative colitis,
69.
Other GI disease: _____________
crohn’s disease)
25.
GI bleeding due to ulcer/laceration
Neurologic:
26.
GI bleeding due to diverticulosis
70.
Intracerebral hemorrhage
27.
Pancreatitis
71.
Subdural/epidural hematoma
28.
Other GI disease: __________
72.
Subarachnoid hemorrhage
73.
Laminectomy/other spinal cord surgery
Neurologic:
74.
Craniotomy for neoplasm
29.
Intracerebral hemorrhage
75.
Other neurologic disease: ___________
30.
Subarachnoid hemorrhage
31.
Stroke
Trauma:
32.
Neurologic infection
76.
Head trauma (with/without multiple trauma)
33.
Neurologic neoplasm
77.
Multiple trauma (excluding head trauma)
34.
Neuromuscular disease
35.
Seizure
Renal:
36.
Other neurologic disease: _________
78.
Renal neoplasm
79.
Other renal disease: _____________
Sepsis:
37.
Sepsis (other than urinary tract)
Gynecologic:
38.
Sepsis of urinary tract origin
80.
Hysterectomy
Trauma:
Orthopedic:
39.
Head trauma (with/without multiple trauma)
81.
Hip or extremity fracture
40.
Multiple trauma (excluding head trauma)
Bariatric Surgery:
Metabolic:
82.
Laparoscopic Banding
41.
Metabolic coma
83.
Laparoscopic Gastric Bypass
42.
Diabetic ketoacidosis
84.
Open Gastric Bypass (Roux-en-Y)
43.
Drug overdose
85.
Vertical Banded Gastroplasty
44.
Other metabolic disease:_____________
Other:
Hematologic:
86.
Other surgical condition:____________
45.
Coagulopathy //neutropeniathrombocytopenia
46.
Other hematologic condition: __________
Other:
47.
Renal disease:_____________________
Form B Patient Registration: INS08
Revised 1 April 08
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