In what order do u treat MI

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morphine, oxygen, nitrates, aspirin?

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Specializes in EMS, ER, GI, PCU/Telemetry.

correct mneumonic, but it now has a B on the end, for beta blockers.

but always remember: AIRWAY FIRST!!

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Specializes in ICU, MICU, SICU.

I'm not sure if you are talking about by ER standards or medics.. but its done a little different on the floor I work on.

Obviously MONA is the correct way.. but honestly when someone starts having an active MI (or so you think) on the floor its more like oxygen, EKG/vitals, nitro, ASA, B-blocker. Its much easier to slap some o2 on then to run and get nitro first, know what I mean?

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Specializes in Pain Management, RN experience was in ER.

If morphine were in the stock carts next to the O2 tubing just ready for us to pull out, our ED would prob be more compliant with MONA. However we usually slap on oxygen first, because it's very easy to throw on some tubing and helps with anxiety over SOB, and maintains sats while we do other tasks. Then we apply the monitor: 02 sats, BP, and EKG. The IV gets started, meds are pulled at once: morphine, nitro, ASA. The whole process is very fast and usually simultaneously: tech/nurse is starting IV, nurse/tech applying leads, while another is pulling meds.

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Oxygen

ASA and nitro (at the same time!)

Morphine if nitro isn't helping

Cardiac enzymes/EKG

STEMI-- up to the cath lab they go!

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I'm not sure if you are talking about by ER standards or medics.. but its done a little different on the floor I work on.

Obviously MONA is the correct way.. but honestly when someone starts having an active MI (or so you think) on the floor its more like oxygen, EKG/vitals, nitro, ASA, B-blocker. Its much easier to slap some o2 on then to run and get nitro first, know what I mean?

Thank you for alll the replys. It sounds like oxygen first because you have to make sure that there is an airway..... and it would be the quickest to do.

what about according to the nclex and acls???? what should u do first????

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Specializes in ER, Med/Surg.

They are now saying that morphine isn't the best thing. It is just the oldest (most widely used). I heard this in ACLS on Friday, but no references to give. They said that Fentanyl was the up and coming pain drug for MI. So I guess 'FONA' will be the new mneumonic.....

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If you factor in EMS, it's probably oxygen, aspirin, nitrates, morphine.

Don't factor in EMS for NCLEX, though.

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Specializes in Critical Care.
morphine, oxygen, nitrates, aspirin?

I was taught: oxygen, nitro, aspirin, morphine

This is also how I've seen it done in practice where I work.

As far as NCLEX, oxygen would definitely be first because you always want to protect your airway and promote oxygenation. The nitro and aspirin would come after that as you want to decrease the workload on the left ventricle as well as decreasing myocardial oxygen consumption with the nitro and promote reperfusion and decrease platelet aggregation with aspirin. Morphine isn't always given-depends on whether the patient is still experiencing chest pain after the nitro.

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Specializes in ER, IICU, PCU, PACU, EMS.

If you're talking about EMS-wise, most agencies in my area are requiring 12 lead ECGs prior to the use of NTG. An inferior MI in the ECG will lead us to do a V4R to r/o a right ventricular MI. RVMI is a contraindication for the use of nitro.

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Specializes in L&D.

I know this an old thread, but I just encountered a question on Kaplan QT 7 about it.

I put oxygen because I thought "airway".

But the right answer was morphine FIRST. O2 2nd.

So I guess for the purpose of the NCLEX, we still use MONA in that order??

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Specializes in Acute Care Cardiac, Education, Prof Practice.

This sounds like a school question, so you might want to check very carefully with what they have listed as appropriate for the NCLEX with your books and/or instructors. I know a lot of us get our own rhythm on the floor and it might not be spot on for the NCLEX as it has now morphed a bit. Though, in a perfect world, it should be the same...but it isn't always.

Personally I slap o2 on, grab a BP, drop a nitro, BP, nitro, BP, nitro. If pain is unresolved I call for a stat EKG and page the doc. We don't have standing orders for morphine, but if for some reason they have it I will then give that if their BP is tolerating. This is from a telemetry med/surg cardiac floor perspective...which as I said can vary from other departments, and can vary greatly from what you might need to say on the NCLEX.

Best of luck,

Tait

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