3 Factors Needed to Have Successful Realistic Simulation Plausible EnvironmentPlausible ResponsesPlausible InteractionFamiliar EquipmentRealistic Simulator EquipmentSeropian, M. Technology, Computing and Simulation (2003) Anesth Analg
4 Importance of Fidelity 3 Fidelities of Patient SimulationEquipment FidelitySimulator versus real equipmentEnvironment FidelitySimulation of Motion, visual and other sensory environmentsPsychological FidelityHow real one perceives the simulated event?Trying to suspend disbelief
5 Why Use Simulated Events Control for the Area of Interest, specific learning outcomesProtect patients/clientsEnsure skills are instructed for specialized skillsCIPs
6 Testing Utilizing Moulage and Simulation More AuthenticEnsure Knowledge and Clinical SkillEnsure flow of communicationScenarios that are rarely encounteredTake out the chance
7 Play like you Practice Never more true Learn From FBI – J Edgar Hoover Practicing CPRNeed opportunity to perform without interruptionMoulage always for more authentic experience
8 Table DiscussionWhat are some of the self-identified challenges for creating moulage and enhancing realism?
13 Lessons from the field (classrooms) AuthenticUse of glovesObvious for external injuriesInternal InjuriesAdd Glycerin & Water to simulate sweating (Elevated Temperature)Blue Watercolors on manikin to cue Hypotension – Mild infection
14 Table Discussion What are you trying to Achieve with Moulage? What have you done to enhance realism?What were the successes and failures?
15 Recipes…Blood Ivory dish soap and red food coloring Darkens as drys just like bloodWILL STAIN (Skin, clothes, manikins, …)One cup corn syrupRed food coloring mixed with 1-3 drops of green or blue food coloringCorn starch to thicken
16 Recipes…More Blood Non-Staining Similar to previous recipes (Dishwashing detergent) with washable poster paint (Red, Black, Blue) and sugar-free chocolate syrup
18 Recipes…Blister / Furuncle with Pus Vanilla pudding with a drop of red, green, or yellow food coloringInject into bubble wrap and seal with crazy glueAttach to surface and cover with “skin”
19 Recipes…Dilated pupils Place black marker dot on old contact and place in eye of manikinDots can vary in size to create aniscoria
20 Recipes…Drainage/Secretions Wound drainage presents itself in a variety of situations; often the drainage is as diverse as the situation. Prior to beginning your moulage, consideration should be given to volume, consistency and odors to assist you in authenticating the scenario you are creating. When crafting your wound drainage, consider the following factors: What type of wound is it? Where is it located? What is the over-all health of the patient?
21 Recipes…Drainage & Secretions (Cont.) Purulent, odorous drainage moulage for healthcare simulation:1 tsp. (condensed) cream of mushroom, chicken or split pea soup2 tsp. Limburger cheese2 drop Kimchee (Chinese seasoning)4 drops waterCaramel food coloring; thinnedIn a small bowl combine cream soup, Limburger cheese, Kimchee and 2 drops of water. Stir mixture well for approximately 1 minute or until thoroughly combined. On wax paper, thin 1 drop of caramel food coloring with 2 drops of water, stirring well with small paint brush. Swirl paint brush with caramel coloring through purulent mixture to impart coloring and add depth.Environmental Settings:Using a small paint brush, apply purulent drainage to 4×4 wound dressing, gauze pads, and internal cavities and crevices of dimensional wounds. Use in conjunction with diabetic foot ulcer and wound dressing drainage. See: MoulageConcepts.com for more recipes.Clean Up:Using soft, damp cloth; wipe odorous drainage from skin of simulator. Treated dressings, gauze pads and wounds can be stored in the freezer indefinitely. Allow mixture to come to room temperature before proceeding to scenario. To refresh odor: Add 1 drop of Kimchee to dressing.Time Saving Hint:Odorous drainage can be made ahead, stored, covered, in the freezer or refrigerator. To reconstitute, add 2 drops tap water and stir several times.
22 Recipe…Simplest Laceration Simplest – slice closed foam surface or suture arm from Life/form ($ 165)Slice manikin face, arm or chest (CPR face – 6 for $ 60)Add color and texture to wound
23 Recipe…Laceration Buildup “skin” Slice “skin” Add color and texture to woundIf want reusable, make wound on wax paper and adhere to person or manikin, peel off after use
24 Recipe…BlisterSimplest – Bubble wrap glued to plate (Especially if practicing lancing and skin removal)Bubble wrap injected with Vaseline or fluid (Seal with crazy glue)For either of the above, add skin built-up / over the top
25 Recipe…Blister Alternate Skin built-upInject Vaseline under skinDrying time issue
26 Recipe…Another Blister Alternate (Burn) Cut a piece of red Saran wrap in shape and size of woundAdhere to siteApply line of liquid latex or “skin” to border of area and into the burn areaPeel and roll inside edgesApply red makeup or lipstick fading towards the edge
28 Recipe…BursitisHand warmer inside Pantyhose over area (Elbow)
29 Recipe…Closed Fracture Tape three straws together with tongue depressorClosed cell foam or small bubble wrapCover with Coban, Pantyhose, or “Skin”
30 Recipe…Open Fracture Tape three straws together with white tape Cover end with dry wall patch materialPaint ends for marrowAdd “skin” over the topAdd blood and makeup
31 Current Projects Suture removal Staple removal Oral cavity & Dental injuriesNasal Plug insertionTop of head lacerationCorneal abrasion
32 Items to Consider (Cautions) There is no known issues/problems with homemade moulageSensitivity to LatexShave area a day or tow before applying liquid latex to skinBe careful with dishsoap use above the neck on real personUse of Sugar type ingredients (Outdoors attracts bugs in summer)Soaking Clogged spray bottles
33 Proper Cleaning Techniques for Manikins Mild dishwashing soapCitrus cleaner (plastic container only – metal container too harsh)Nothing with acetone on manikins as will desolve manikin clear coat and paint already on manikin (Eyebrows, …)Wet wipes (without bleach)Isopropyl alcohol wipes or gauzeAnything you would use on the inside of your car can usually be used
34 Methodist University Fishing Challenge Online Fishing TournamentAT Programs ChallengeMost Points, ParticipantsProceeds to benefit NATAREFRegister ($ 25), Fish, fish photo to win