ED physicians are only about 80% accurate in their diagnosis of acute CHF. Why? Well, there's no

single element of the past medical history presenting symptoms or physical exam findings that can

reliably rule in or rule out acute CHF in the ED. Orthopnia, P&D, weight gain, are not

especially helpful in making the diagnosis, and even the lauded S3 Gallup, which most of us can't identify at the best of times in the ED, isn't really a slam dunk.

Well, what about the x-ray, you might ask? Surely a chess x-ray can help us rule in or rule out CHF with good accuracy.

Well, not so much.

The classic signs of CHF are often absent on chest x-ray,

an inter-observer agreement, whether you're an ED doc or a radiologist

on the diagnosis of CHF by X-ray, is enormous.

Despite these shortcomings, when all of these

elements are put together, ED physicians' clinical gestalt is actually not bad at diagnosing

CHF. But maybe we could be better. Enter B&P. B&P is currently in use in many EDs across North America,

but does it improve our diagnostic accuracy above and beyond our clinical gestalt?

Does it help us distinguish between that COPD who comes in in Dysmniac, who might be in CHF,

but it could also be COPD exacerbation, and we're not really sure.

Well, in this journal jam podcast, we discussed the clinical utility of BNP and the workup of

the dysmniac ED patient while covering most of the world's literature on the topic.

We not only asked does BNP add much beyond physician Gestalt, but also are there a specific

subset of patients that BNP might be useful for?

Should we abandon BNP as a dichotomous rule-in, rule-out variable and instead use it as a

continuous variable?

Or maybe use it like we use lactate and sepsis as a prognostic tool?

...