What order to give MONA?

[xmilkncookiesx, RN]

I am studying MI and I've been told different ways to give MONA. I went onto ACLS site and although it says MONA isn't given the way it looks, it doesn't provide the actual steps.

Here is what my critical thinking is if a patient came into the ED. and please correct me if I'm wrong:

Patient comes in c/o CP. The patient is diaphoretic, SOB, nauseated, radiating pain to jaw, neck, arm (all left side).

I would assess them (full cardiac assessment, and respiratory assessment), ask OPQRST questions, then put an EKG on them and maintain it, start IV line, then as per order slap O2 on them, administer ASA (chew and swallow), nitro (SL), morphine, then if theres any other standing orders like a BB or heparin, administer those as well.

I feel like I may have something wrong??

[Here.I.Stand, BSN, RN]

ACS algorithm with elaborations --

Acute Coronary Syndromes Algorithm

O2 not indicated unless satting

[Here.I.Stand, BSN, RN]

My most recent ACLS instructor said about slapping on O2 with sat >95 and no SOB: "Why do we still put it on everyone? Because it makes us feel better."

[CelticGoddess, BSN, RN]

My most recent ACLS instructor said about slapping on O2 with sat >95 and no SOB: "Why do we still put it on everyone? Because it makes us feel better."

Very good point. It does help to ease anxiety. And that's about all it does when your sats are good.

[That Guy, BSN, RN, EMT-B]

Oxygen is always something that is quick and dirty for acute hypoxia so that is easy. In terms of meds, the only one that actually does anything is the ASA so that is the most important. The others have fallen to the wayside in terms of given to every single pt.

[Castiela]

I would probably start a few IVs, especially if the Cath lab isn't available. It's preferable not to have to start IVs if your patient receives thrombolytics.

Don't forget to assess for other causes of chest pain ( aortic dissection, heart burn- really depends on your ecg results)

I would also draw up a full panel including troponins.

[chare]

You might find the following helpful.

• 2010 AHA guidelines for CPR & ECC Part 10: Acute Coronary Syndromes.
  
• 2015 AHA guidelines for CPR & ECC Part 9: Acute Coronary Syndromes.
  

[xmilkncookiesx, RN]

I would probably start a few IVs, especially if the Cath lab isn't available. It's preferable not to have to start IVs if your patient receives thrombolytics.

Don't forget to assess for other causes of chest pain ( aortic dissection, heart burn- really depends on your ecg results)

I would also draw up a full panel including troponins.

So would it be best to start 2 IV lines, since heparin might be given, and then to draw blood?

[xmilkncookiesx, RN]

Also ... if the troponin levels are elevated, what do I do? I know its elevated when there is CP and indicates that there has been some injury/damage to the heart.

Would I call the MD and get orders on what to do? Maybe give the nitro if ordered?

I'm trying to think as if this was actually all in the ED, and treat the patient like its an emergency. Trying to prepare for SIM and the real world lol

[Castiela]

So would it be best to start 2 IV lines, since heparin might be given, and then to draw blood?

It's not the heparin as much as the streptokinase ( breaks up clots) which can result in a large bleed. Generally you don't want punctures in non compressible sites.

If you troponins increased, I would call the doctors. By the time the troponins results come back, your patient should already be getting prepped for Cath lab or receiving streptokinase, so they might not do a ting further. If the patient is still having chest pain despite interventions, I would also alert the doc. As long as it isn't a contraindication to nitro (inf MI c right sided involvement/viagra/cialis etc) try might put on a nitro infusion.

If the patient is a known stroke and being treated, the docs probably won't do much. However, a new elevated trop will result in an ecg, Asa, a cxr, etc.

[nursinghealth]

Definitely call the MD. Don't initiate anything except O2 without either a Medical Directive, existing PRN order, or new order from the MD.

[JKL33]

Definitely call the MD. Don't initiate anything except O2 without either a Medical Directive, existing PRN order, or new order from the MD.

The question is in regard to a protocol that is, in many places such as EDs, usually already in effect.