The patient with palpitations and sharp chest pain that is worse with inspiration than expiration is brought to the emergency department (ED). Upon auscultation of heart sounds, the nurse notes a scratching noise, like leather rubbing together. Breath sounds are clear and equal bilaterally. Complete blood count is notable for leukocytosis; cardiac enzymes are within normal limits. The nurse prepares the patient for which treatment?

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Intravenous indomethacin. The patient with a pericardial friction rub and leukocytosis with normal cardiac enzymes likely has pericarditis. Treatment of choice for pericarditis is a non-steroidal anti-inflammatory drug (NSAID), like IV indomethacin. Inhaled beclomethasone is a bronchodilator used to treat asthma. Nitro paste would be indicated if cardiac enzymes were elevated suggesting a myocardial infarction. Intravenous corticosteroids are not the first line treatment for pericarditis; they are only used if it is refractory to NSAID therapy.

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