Hypoxic Respiratory Failure (COPD exac, CHF Exac, Pneumonia)

This is one of the most common diagnosis I admit as a hospitalist, and often my patients usually have COPD, & CHF. They end up getting treated for both COPD exacerbation and CHF exacerbation and sometiems if the CXR is unclear (edema vs infection), they get treated w/ abx as well. Lot of waste and side effects. Besides the obvious fever, WBC count, what else do you guys use to confidently discriminate between these etiologies. Procalcitonin is one lab I use. Wheezing (could be present... Hypoxic Respiratory Failure (COPD exac, CHF Exac, Pneumonia)
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