High risk patients include the following:
subacute onset
high fever (> 100.4 F/38 C) and leukocytosis
development of cardiac tamponade
large pericardial effusion (echo-free space > 20 mm) resistant to NSAID treatment
immunocompromised
history of oral anticoagulation therapy
acute trauma
failure to respond to seven days of NSAID treatmentPericardiocentesis is a procedure whereby the fluid in a pericardial effusion is removed through a needle. It is performed under the following conditions:
presence of moderate or severe cardiac tamponade
diagnostic purpose for suspected purulent, tuberculosis, or neoplastic pericarditis
persistent symptomatic pericardial effusionNSAIDs in viral or idiopathic pericarditis. In patients with underlying causes other than viral, the specific etiology should be treated. With idiopathic or viral pericarditis, NSAID is the mainstay treatment. Goal of therapy is to reduce pain and inflammation. The course of the disease may not be affected. The preferred NSAID is ibuprofen because of rare side effects, better effect on coronary flow, and larger dose range. Depending on severity, dosing is between 300 and 800 mg every 6–8 hours for days or weeks as needed. An alternative protocol is aspirin 800 mg every 6–8 hours. Dose tapering of NSAIDs may be needed. In pericarditis following acute myocardial infarction, NSAIDs other than aspirin should be avoided since they can impair scar formation. As with all NSAID use, GI protection should be engaged.
A bone fracture  (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of a bone. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture. Signs and symptoms
Although bone tissue contains no pain receptors, a bone fracture is painful for several reasons:
Breaking in the continuity of the periosteum, with or without similar discontinuity in endosteum, as both contain multiple pain receptors. Edema and hematoma of nearby soft tissues caused by ruptured bone marrow evokes pressure pain. Involuntary muscle spasms trying to hold bone fragments in place.Damage to adjacent structures such as nerves, muscles or blood vessels, spinal cord, and nerve roots (for spine fractures), or cranial contents (for skull fractures) may cause other specific signs and symptoms. Complications
Some fractures may lead to serious complications including a condition known as compartment syndrome. If not treated, eventually, compartment syndrome may require amputation of the affected limb. Other complications may include non-union, where the fractured bone fails to heal or mal-union, where the fractured bone heals in a deformed manner.