The Scalpel Cocktail
Everybody knows about the GI cocktail. The green dragon: a mixture of Maalox, Donnatal, and viscous lidocaine which has been soothing upset stomachs for generations of ER visitors. In my experience, it seems that most docs just use the dragon for GERD, gastritis, or ulcer-like symptoms. I've found that a simple modification makes this old standby useful for uncomplicated patients with gastroenteritis as well.As I've mentioned before, I think we overtest and overtreat many cases of "stomach flu." An otherwise healthy low risk patient who maybe threw up once and is now having mostly cramps and diarrhea with a side of nausea doesn't necessarily need an IV and a thousand dollar workup, so sometimes I try this first:
Just substitute Zofran elixir for the viscous lidocaine.
If you don't stock the elixir form, you can squirt the IV form of Zofran right in the cup with the Maalox and Donnatal and mix well. Yes, the IV form can be taken orally, it is just as effective, and I find that 4 mg is sufficient most of the time. The Zofran stops the nausea, the Maalox soothes their stomach, and the Donnatal relieves the cramps. The lidocaine just tastes bad and numbs their throat, so I leave that part out.
In 10 minutes the majority of these carefully selected patients are going to be ready to go home, asymptomatically singing your praises as they leave. Some of them won't, and they will require the 2-4 hour workup and treatment plan you were going to do anyway.
posted by scalpel at 8:03 AM
17 Comments:
I'd leave in the lidocaine, because patients figure that anything that tastes that nasty MUST be pretty strong medicine, right?
I don't think I could have a stomach upset enough to drink that awful sounding concoction. How (and why)do people with vomiting and diarrhea ever make it out of the house to the ER? I had food poisoning once from the local Arby's and there was no leaving the pot until the bacteria had run it's course. Once the NVD subsides enough to go anywhere, what's the point?
It worked for me..... :-)
Around our ED we call it the "Green Goddess." Man, it works great. But I'm going to suggest your cocktail next time.
zofran is the best. stuff. ever. even if it does cost a bajillion dollars and requires you to sell your firstborn child to your insurance company to get even the generic ondansetron authorized.
(ondansetron has to be my favorite drug name for the images of disco-dancing robots that it conjures)
When I was a pup as an ER EMT, it was called the GGD, as patents nearly invariably said "g**-damn" on swallowing. Oh, and it was green.
I'm going to try this (after a consultation with our ED pharmacist) with and without the Lido, and see what happens. Exclusion of the lidocaine I like, empirically. Good idea!
I see a study coming on.
GruntDoc.
The ED nurses would give me the green stuff when I didn't feel good while working and it always helped. they never called it the green dragon though. I will have to tell them. I don't think they put lidocaine in it though.
Our GI cocktails are just lido 15cc and maalox 15cc. No green stuff. Never heard of the green stuff nor seen the green stuff.
All these people want narcotics anyways, so no addt'l ingredients will do anything anyway.
Edited to suggest using the elixir form of Zofran. Initially our facility didn't carry the elixir...that's how I started using the IV form orally. For kids, just mix it with a few mL of juice.
Zofran is responsible for a quantam leap in the management of pediatric gastroenteritis. What used to be a frustrating tedious drawn-out process is now a 15 minutes sticker-carrying out-the-door-smiling BYE-BYE!
It's worth the money.
Hmmm . . . I like it.
I have the flu right now, and the the thought of drinking that green bleck is enough to send me running for the porcelain throne. Again.
WE always called it the green grasshopper but NOW our donnatal comes purple! Anyone have a good name for a purple GI cocktail? I like the lido for gastritis/GERD sx but it probably wouldn't do much for gastroenteritis.
How about "Barney?"
Interesting, I'll give it a try.
Is that a random wizard hat, or the one you actually take to work?
Zofran is the shiznit!
Hey, I just happened to be researching the Cocktail I was given in the ER before they found my GERD and Ulcer... I tell you this stuff was magical. I've never had pain relief this instantly. It was like cloud 9. Whoever invented the concoction should have received the Nobel prize.
I was given this when I came in with esophageal spasm. I'm also a heart patient post CABG so it really muddied the waters since it mimics cardiac pain so well. The Green Dragon was a quick way to sort it out and relieved the pain completely.
As for coming in with stomach flu, I once had it so bad I was losing fluids rapidly at both ends and my potassium was dropping so we loaded me up with towels and got me in so I could replace my fluids and balance the electrolytes. Zofran was my savior. :)
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