內科送ICU order

### [ICU Transfer Note / STAT Order]

**1. Transfer Diagnosis & Indication (轉科原因與適應症)**

- Impending Respiratory Failure (即將發生的呼吸衰竭)

- Altered Mental Status (意識狀態改變/Coma)

**2. Clinical Event Timeline (事件精準時間線 - 防禦性紀錄)**

- 11:15 AM: SpO2 dropped from 92% to 90%. Informed Primary MD. 

- [Note]: Per MD instruction, "Observation only if SpO2 < 90%". (醫囑備註：醫師要求90%以下再開始觀察)

- 11:20 AM: SpO2 dropped to 88%. Patient showed respiratory distress & paradoxical breathing.

- 11:22 AM: Escalated O2 therapy to Non-rebreather mask (15L/min). 

- 11:25 AM: Urgently paged MD again. MD arrived at 11:35 AM for evaluation.

- 11:45 AM: Patient mental status progressed to Coma. Initiated ICU transfer protocol.

**3. Current Respiratory Support (目前呼吸支持)**

- O2 Device: Non-rebreather Mask @ 15L/min.

- Airway: Oropharyngeal airway (OPA) inserted. Suctioned moderate thick yellowish secretion.

- SpO2: 88-90% (Under high-flow O2).

**4. Final Vital Signs (離開病房前最後快照)**

- T/P/R: 37.2 / 128 / 32 (Tachypnea)

- BP: 165/98 mmHg

- GCS: E2V1M4 (Coma scale)

**5. Tubes & Access (管路與治療)**

- IV Access: 20G on Left forearm (Patent).

- Tubes: N-G tube (Room drainage), Foley catheter (Patent).

- Meds: All routine meds held due to acute change.

**6. Pending Issues (待追蹤事項)**

- ABG (Arterial Blood Gas) drawn at 11:40 AM - Result Pending.

- Family notified about the critical condition and ICU transfer.