Wound of the Month: Swelling, Non-pitting Edema

A guide to simulating injuries through effective use of moulage


Time: 3-5 minutes. See Figure 1.

Skill Level: Beginner

Supplies: (Find supplies and more at www.moulageconcepts.com.)

Flesh-colored moulage gel

Red moulage gel

2–3 cotton balls, shredded

Single large bubble from bubble wrap sheet

Equipment:

Hotpot

Laminated board

20 cc syringe

Palette knife

Technique:

See Figure 2.

Heat the moulage gel to 130°F. On a laminated board, combine 10 cc of flesh-colored moulage gel with three drops of red moulage gel. Stir the moulage gel material thoroughly with the back of a palette knife to blend, creating a light pink color. Allow the mixture to set fully before pulling up and re-melting in a 20 cc syringe. Carefully grasp the packing bubble and insert the tip of the syringe through the back, puncturing the bubble. Express the gel to fill the bubble until it’s approximately half to three quarters of the way full. (More gel = increase in swelling depth.)

See Figure 3.

On the laminated board, create a thick basic skin piece approximately 5–6 inches in diameter. Working quickly, gently place the shredded cotton over the center of the skin piece, extending the cotton outward toward the skin piece edge, while maintaining a half inch “moulage rim” around the perimeter.

See Figure 4.

Using moulage gel as a glue, secure the filled packing bubble, centered, over the cotton. Allow the wound to set for several minutes before proceeding to scenario.

Quick Fix:

To create an insect bite with a firmer feel at the entry point, glue the filled packing bubble directly to the underside of the skin piece prior to adhering cotton. Carefully glue the shredded cotton over and around the packing bubble (maintaining the rim) using the moulage gel.

Dispatch:

Medic 12 Respond Code 3 allergic reaction, unknown injuries. “Miracles Forward” Work Training Center (WTC). Lincoln Street, nearest cross street, Monroy Ave. Pleasanton Fire responding. 1305 hours. Dispatch clear.

On Scene:

Using a make-up sponge or your fingers, liberally apply red make-up to the cheeks and chin of the patients’ face, blending well. Apply a light mist of sweat mixture to the chin, upper lip and forehead. Using moulage gel and a small paint brush, paint the underside of the swelling wound, along the “rim,” and quickly adhere the wound face up to the skin of the patient along the collar bone. Instruct the patient to not answer questions, avoid eye contact with responders, rock back and forth, and display difficulty breathing, restlessness and agitation.

Use in Conjunction With:

Insect bite

Skin mottling

Hives

Helpful Hint:

Swelling wounds can be made in advance, stored covered in the freezer and reused indefinitely. Allow the wound to come to room temperature at least five minutes before proceeding to "On Scene."

Cleanup and Storage:

Gently remove the swelling wound from the skin of the patient. Store wounds side-by-side, but not touching to avoid cross-color transference, on a waxed paper-covered cardboard wound tray. Loosely wrap trays with plastic wrap and store in a freezer. Using a soft, clean cloth or make-up remover towelette, wipe away the make-up and sweat from the skin of the victim.

Bobbie Merica is the author of Medical Moulage: How to Make Your Simulations Come Alive, Moulage! Bridging the Gap in Simulation and Moulage Magic! Theatrical Tricks to Bring Simulation to Life. All works are based on her popular Moulage Mastery! Bridging the GapTM in Simulation workshops. She received her certification in Moulage-The Art of Injury Simulation; Biological/Chemical/Terrorism and WMD terrorism training through TEEX. Upon discovering the absence of moulage specific to a clinical/hospital setting, she designed and implemented the first of a series of 3D clinical wounds, moulage kits and courses that she teaches all over the country. She began her career as a simulation technologist with California State University, Chico, where her collaborative work in the development of the Rural Northern California Simulation Center earned runner-up honors in Advance magazine 2009 Best Nursing Team contest. She is a contributing author for EMS World and HealthySimulations.com, and medical moulage & trauma expert for the Bureau of Public Health Emergency Preparedness, AZ. She will be offering the Medical & Trauma Moulage Workshop for Simulated Clinical Experiences, August 29–31, at the Little America Hotel & Resort in Cheyenne, WY. For more information, visit www.moulageconcepts.com.

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