These authors make a brief argument regarding the inappropriateness of the commonly taught acronym of "MONA" for the initial treatment of acute coronary syndrome. It is probably the case that well-read Emergency Physicians have since moved on, but it bears repeating.
- Morphine, which has been associated with worsened outcomes in CRUSADE, but the results are confounded by other factors. Narcotics are still probably reasonable for nitrate-resistant pain.
- Oxygen, in which hyperoxia is associated with coronary vasoconstriction, exacerbates reperfusion injury and infarct size. It is currently recommended that oxygen only be used for patients who are hypoxic.
- Nitrates, suitable for the relief of anginal symptoms in selected patients.
- Aspirin, the only element of MONA proven to be strongly beneficial.
And, presumably, future trials will involve the use of newer anti-platelet and other agents in the inital treatment of ACS.
The market is ripe for a replacement acronym!
"Initial treatment of acute coronary syndromes. Is there a future for MONA acronym after the 2010 guidelines?"