A 50 y/o man with a history of CHF and COPD is brought in by ambulance in severe respiratory distress. He is sitting upright with a RR 30 and O2 saturation of 79% on room air. Is this a CHF or COPD exacerbation? This is a common dilemma faced in the ED. Fortunately there are likelihood ratios to help you risk stratify using a Fagan nomogram.
Note that there are 3 tables:
- All-comer Emergency Department (ED) patients1
- ED patients WITH a known history of asthma or COPD2
- Summative LRs for BNP are provided in ED patients with or without a history of asthma/COPD1
See the blue font for the likelihood ratios ≥ 3.0.
PV Card: Does Your Dyspneic Patient Have CHF?
Adapted from [1, 2] Go to ALiEM (PV) Cards for more resources.
- Wang C, FitzGerald J, Schulzer M, Mak E, Ayas N. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944-1956. [PubMed]
- McCullough P, Hollander J, Nowak R, et al. Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department. Acad Emerg Med. 2003;10(3):198-204. [PubMed]