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Why was morphine given to patients with Mona?
Aug 02, 2011 · Intravenous morphine sulfate is used appropriately for many patients presenting with an ACS, who continue to have symptoms related to myocardial ischemia (usually chest pain) despite aggressive therapy with nitrates, β‐blockers, and angiotensin‐converting enzyme inhibitors (ACEI). Unfortunately, many patients with an ACS who have not been treated …
What is Mona for chest pain?
Apr 04, 2020 · To the Editor: The mnemonic, MONA, which stands for morphine, oxygen, nitroglycerin, and aspirin, is used to recall the initial man- agement of patients with chest pain (ie, suspected acute cor- onary syndrome). However, in the era of evidenced-based medicine, a review of this mnemonic is needed (Fig. 1). Likewise, do you give oxygen for chest pain?
Should morphine be used to treat chest pain?
Aug 22, 2018 · Morphine also slows the heart rate and has a vasodilating effect because it is a narcotic, but it was not generally given for those specific reasons. It would have been given if the nitrates did not relieve the chest pain or if the patient continued having significant anxiety. Updated Recommendations for MONA (based on recent research)
What is the role of morphine in the treatment of mi?
The characteristics of chest pain due to suspected acute myocardial infarction and morphine use during the first 3 hospital days are described in a population of 2988 consecutive patients admitted to hospital. The duration of pain was usually less than 24 h (mean 20.9+/-0.55 h), and only 24.8% of patients experienced chest pain of longer duration.
What does Mona stand for?
What is MONA for Heart Attack? First, for those who don’t already know, MONA is a mnemonic that stands for: M orphine, O xygen, N itrates, and A spirin. These are the 4 primary interventions that used to be routinely performed when treating a patient with suspected Heart Attack/Myocardial Infarction (MI).
Why is oxygen used in myocardial infarction?
Oxygen therapy has a long history of being used for Myocardial Infarction ever since it was discovered to improve angina way back in a research study in 1900 . So the Oxygen was most often given first in emergency treatment of heart attack to start increasing the amount of available oxygen in the blood.
Why would nitrates be given to vasodilate blood vessels?
Second, nitrates would have been given to vasodilate blood vessels, which presumably allowed more room for blood to pass through the cardiac blood vessels. Then the aspirin would be given to help “thin” the blood by breaking down platelets.
What is the first thing you give a patient with myocardial infarction?
In a medical setting, when treating a patient with Myocardial Infarction, it used to be recommended to give: Oxygen first, then nitrates, then aspirin, then morphine. The rationale was that there were two therapeutic goals:
Why do they say aspirin comes first?
You probably heard the “aspirin comes first” recommendation because if a patient calls 911 for chest pain, they will probably be instructed to take an aspirin while waiting for the ambulance.
What is the best medicine for clots?
Basically, the only MONA recommendation that remains unchanged is this one: take aspirin. Aspirin still helps to prevent additional clots from forming by reducing the ability of platelets to stick together, which is something that can prevent further cardiac damage.
Can you take morphine during a heart attack?
Other research studies have found no change in mortality or complications. Bottom line: Don’t routinely administer morphine during myocardial infarction.
Why do we give morphine?
The old rationale was to give morphine for pain relief, decrease heart rate and anxiety, and decrease oxygen demand. Oxygen was used on everyone to increase the blood oxygen levels.
When to use oxygen titration?
Oxygen is only used on patients who are hypoxic, SOB, and/or have obvious signs of heart failure. Be careful when titrating oxygen to keep saturations > 94% not to hyper-oxygenate your patient. Morphine should only be used now on patients having a STEMI when the nitroglycerin doesn’t relieve the pain.
What is the difference between nitroglycerin and aspirin?
Nitroglycerin was to vasodilate blood vessels and increase coronary circulation. Aspirin was to slow platelet aggregation to increase circulation past the blockage. Today, morphine and oxygen, have reduced emphasis. The fist thing to give is aspirin and then nitroglycerin.
What tests should be done at a later time?
The doctor will order other tests as well, such as, a chest x-ray, cardiac markers (troponin, CK, myoglobin), and CMP. A stress test and carotid ultrasound may be ordered also at a later time.
When was morphine used for MI?
Clinicians have used morphine for pain associated with MI since the early 1900s. The drug’s use through today is largely based on the “it’s always been done it this way” school of thought.
What are some alternatives to morphine?
The study authors summarized alternatives to morphine, including acetaminophen for pain measuring less than 7 on a visual analogue scale; alfentanil, which has some limitations; and drugs in the naloxone, naloxagol, and methylnaltrexone family.
What causes diaphoresis in myocardial infarction?
Pain can activate the sympathetic nervous system and cause diaphoresis, weakness, light-headedness, and palpitations in patients with myocardial infarction. Myocardial infarction (MI) is a painful condition with tightness, pressure, or squeezing pain in the chest for approximately 75% of patients who experience it.
Does morphine slow down platelet absorption?
The study authors also reported that morphine may inhibit and de lay oral antiplatelet drug absorption. Rapid platelet inhibition is the cornerstone of treatment in acute coronary syndrome, and any slowing of antiplatelet effect may worsen outcomes.
What is morphine used for?
Oral (liquid) morphine solutions are commonly used in palliative care and hospice settings, and often are included in the "hospice kit" provided to loved ones to administer if or when needed. 2
Why is morphine used in hospice?
Liquid morphine is often provided in a hospice kit so that family or friends can treat their loved one who is dying. 1 It's important to note that you can always contact your hospice nurse or physician if you have questions about the use of morphine.
How long does morphine last?
An oral/liquid morphine solution typically starts working quickly—usually within 15 minutes— and lasts for roughly 4 hours, although some people might find they require morphine more often. Morphine tastes bitter, which is most noticeable in the liquid form in contrast to pill form.
When will morphine be available in 2021?
on February 03, 2021. Many people wonder about the uses, forms, and side effects of morphine, especially since morphine sulfate is perhaps the most misunderstood and the most feared of all the medications used to treat pain. Commonly used in hospice and palliative care settings to treat people nearing the end of their lives, ...
What does it mean when you hallucinate?
Tightness in the throat. Difficulty swallowing. Swelling of the arms, hands, feet, ankles, or lower legs. It's important to note that many people appear to hallucinate at the end of life whether they are receiving morphine or not.
What are the side effects of morphine?
All serious side effects of morphine use should be reported to your doctor immediately, and can include: 4 . Slow, shallow, or irregular breathing. Blue or purple color to the skin. Fast or slow heartbeat. Seizures. Hallucinations (seeing things or hearing voices that do not exist)
Does morphine help with shortness of breath?
Morphine is also effective in treating dyspnea, or shortness of breath, a symptom experienced by a very large number of people at the end of life and sometimes more distressing than physical pain. 3 Morphine can reduce the anxiety associated with shortness of breath but actually improves breathing by dilating blood vessels in the lungs and deepening breaths. Other medications in the hospice kit may reduce anxiety, but can actually worsen dyspnea.
When should I use morphine?
Morphine should only be used when the patient has pain, and is probably best reserved for severe pain, as the safety of its use is not clear. While hypoxemia is a common consequence of MI – and may correlate with worse outcomes – treatment with supplemental oxygen in the absence of hypoxemia is not supported by current evidence, ...
What is the treatment for chest pain due to myocardial ischemia?
Greta Tubbesing, MD. For many years, a standard treatment of providing morphine, oxygen, nitroglycerin, and aspirin (MONA) was the standard initial treatment approach for all patients presenting with chest pain due to suspected myocardial ischemia.
When was oxygen first used for MI?
The practice of using supplemental oxygen to treat all patients with MI became standard nearly a century ago, after oxygen was found in 1900 to relieve angina, and led to clinical improvement in four MI patients in a 1930 case series. 5,6.
Can nitroglycerin cause hypotension?
Nitroglycerin would be problematic, as it appears that this patient might be having a right ventricular infarct, and lowering right-sided filling pressures with nitroglycerin may lead to severe hypotension. There is controversy over the safety of routine morphine use for patients with chest pain.
How often should you refill nitroglycerine?
Counsel your patients with nitro prescriptions to not carry their bottle in their pants pockets and to refill the prescription every six months. Note also that plastic containers leach nitroglycerine from tablets and from intravenous preparations.
Who is Mike McEvoy?
Mike McEvoy, PhD, NRP, RN, CCRN is the EMS Coordinator for Saratoga County, New York and a paramedic supervisor with Clifton Park & Halfmoon Ambulance. He is a nurse clinician in cardiothoracic surgical intensive care at Albany Medical Center where he also Chairs the Resuscitation Committee and teaches critical care medicine. He is a lead author of the “Critical Care Transport” textbook and Informed® Emergency & Critical Care guides published by Jones & Bartlett Learning. Mike is a contributor to EMS1.com and a popular speaker at EMS, Fire, and medical conferences worldwide. Contact Mike by email.
What is the most common nitrate?
The most common nitrate is nitroglycerine, available in many different forms, all of which offer the beneficial effects of dilating coronary arteries (particularly in the areas where plaque disruption may be blocking blood flow), and dilating venous blood vessels which reduces resistance to blood flow in the body.
Can nitrates be used for chest pain?
This is great news for BLS providers who are trained and ready to deliver both medications currently recommended for chest pain patients.
Does storing nitrous in a pocket help?
Storing the bottle in a pants pocket increases temperature and will accelerate nitro degradation. Tablets that have lost their potency have a sweet taste; tablets with full potency taste bitter, commonly induce a headache, and (obviously) help to relieve chest pain.
Does Mona answer the door?
MONA no longer answers the door. Morphine, oxygen, nitrates, and aspirin — collectively known as MONA — are no longer the preferred door prizes for chest pain patients entering the emergency cardiac care system. The Emergency Cardiac Care (ECC) Guidelines 2010 put the kibosh on the morphine and oxygen piece of MONA after research demonstrated ...
Is there a new aspirin?
There is also a new powdered aspirin product on the market contained in a foil envelope ( Aspirin to Go) that can be kept in a wallet or pocketbook and used in case of headache, injury or administered as a lifesaver in a chest pain emergency.