Moulage: Nuts & Bolts

Krista Kipper BSN, RN HealthPartners Clinical Program Manager

Moulage

 Moulage – The artistic technique of incorporating realistic cues, such as wounds, perspiration, blood, or therapeutic devices, to increase the “psychological fidelity” of a simulation.

Clinical education that measurably improves care .

    Alignment with objectives Participant considerations – Level of experience – Environment – Inter-professional education Subject – Human – Mannequin Knowledge – Physiology of the situation – Mechanism of injury

Clinical education that measurably improves care .

Considerations

Clinical education that measurably improves care .

What do you need?

Moulage Supplies

       Wigs – Halloween purchase Wounds & Incisions – Halloween purchase Eye Shadows & Blushes – Many colors Make-up brushes Water Color markers Finger paints Distilled water      Dish detergents – – Blue White – Pink/red White shaving cream Red bubble wrap Red plastic food wrap – Winter holiday purchase Food coloring

Clinical education that measurably improves care .

Moulage Supplies cont…

   Artificial blood Spray bottle – Distilled water to spray diaphoresis – Scented concentrate  Liquor/alcohol  Fruity for DKA breath Adhesives – Tapes – Tegaderm

Clinical education that measurably improves care .

  “White” eraser Powder

Clinical education that measurably improves care .

Body Fluids Magic

Moulage Supplies cont…

 Mixing Basics – – Secure locking containers Spoons – Leur-lock syringe – Cath tip syringe – Drainage bags for IV fluids – Funnels – Measuring cups

Clinical education that measurably improves care .

 Avoid – Mold Growth

Food Products?

Clinical education that measurably improves care .

Food products?

 Possible Exceptions: – No direct contact with mannequin  Edema: Cream of wheat/oatmeal in secured bags covered with nylons  Coffee grounds added to a fluid presented in a basin – Cornstarch for thickness – Rice crispies/broken chips in a baggie for crepitus – Plain gelatin with red food coloring for clots

Clinical education that measurably improves care .

Human Subjects

 Benefits – Blending make-up for bruises is easier – Adhesives stick better – Individual can assist with device or moulage – Individual can assist with clean up – Realistic facial expressions and movement

Clinical education that measurably improves care .

Human Subjects

 Limitations: – Need breaks – May have allergies to moulage/device materials – Inability to perform all “critical actions” when simulating a medical emergencies (ie. Intubate) – Limitations to the application of devices (ie. Foley) – Limitations related to exposure

Clinical education that measurably improves care .

Mannequin Subjects

 Benefits – More realistic device application (ie. Intubation) – Easy exposure – Ability to alter physiological findings – No allergic concerns – No timing issues related to breaks

Clinical education that measurably improves care .

Mannequin Subject

 Limitations: – Lack of movement & facial expressions – Devices do not fit realistically – Surface staining – Realistic blending of make-up is challenging – Variances' to the adhesive qualities of materials

Clinical education that measurably improves care .

Human

Example of Bruises

Mannequin

Clinical education that measurably improves care .

Clinical education that measurably improves care .

Example of Bruises

Example of Wounds

Clinical education that measurably improves care .

Example of Wounds

Clinical education that measurably improves care .

Clinical education that measurably improves care .

Example of Burns

Clinical education that measurably improves care .

Example of Burns

Moulage Supplies cont….

 Basic device needs – Dressings – Basins – Drainage collection devices  IV infusion over flow  Foley  Stool collection device – Medications – – Intravenous supplies Chux – Armbands – – Oxygen flowmeter Oxygen Adjuncts

Clinical education that measurably improves care .

Medical Supplies cont…

Additional medical device considerations:

– – – – – – – – – – – – Bag valve mask Splints C-collar Backboard Traction Chest tubes JP bulbs IV pumps Feeding pumps Feeding tubes Suction Canister Yankeur

Clinical education that measurably improves care .

THE LIST IS ENDLESS!!!

Show me the money!!!

     Use expired materials (ie. Medications, defib pads) Repackage materials (ie. Cath kits, central line kits) Predetermined disposal site Make friends with ancillary departments (ie. Pharmacy, Biomed, Materials) Refill & Reuse… Reuse… Reuse

Clinical education that measurably improves care .

Sample Recipe

 Meconium – Green finger paint – Yellow finger paint – Blue dish detergent Mix finger paints, adding until desired color. Add dish detergent for color and consistency.

Clinical education that measurably improves care .

Sample Recipe

 Liquid C-diff Stool – – ½ cup Corn starch 2 tsp Shaving cream – Black finger paint – Green finger paint – Red finger paint – 2 drops green food coloring – 1 drop red food coloring – Blue dish detergent Pour distilled water into a bowl for the approximate amount of stool, add green and red finger paints to make a brown color, add a tiny amount of black finger paint and food coloring. Mix corn starch, shaving cream, and blue dish detergent for realistic consistency.

Clinical education that measurably improves care .

 Blood Clots – – 1 box Gelatin Food coloring – Water

Clinical education that measurably improves care .

Sample Recipe

 Mix according to box directions but use half as the amount of water. Add food color until desired color obtained. Pour into a cake pan (9x13). Place in refrigerator overnight to settle.

Assignment

 Bruise – New – Older  Oozing blood  Make the moulage needed for your simulation

Clinical education that measurably improves care .