Training Scenario: Place multiple adult simulators on ground near dock. Using a pair of scissors, create large cuts, tears and rips on clothing. Using a flesh tone moulage gel, apply a thick layer of gel to exposed skin of simulator, under the cut clothing. Using a stipple sponge, press the edges of torn clothing into the moulage gel, blotting gently to create a textured appearance. Apply scalding burn moulage wounds to hands, wrist, neck, face and exposed skin on simulator. Apply a light mist of pre-made sweat mixture to the forehead, chin, neck and upper arms. Create eye reddening around the upper and lower eyelids. To create Eye Reddening: Using SIM-Safe red make-up, carefully apply red colorant to upper and lower eyelash line using a small paint brush or cotton swab.

Patient Chart

Include chart documentation that supports ambulance report, history, and Dr. orders Use in Conjunction With (simulated): Skin reddening Blisters

What the experts have to say:

Simulation Coordinator:

Developing reasoning skills becomes a major focus in healthcare education. During meetings with clinical partners who may hire new graduates, I have heard a very consistent concern, “Teach them to think. We can teach them skills, but we need them to be able to think!”

In my experience as an educator I have realized pre-licensure learners tend to focus on interventions. Guiding them to go beyond managing symptoms, to be methodical in their thinking, is always an educational priority. Correct and thorough assessment is a requirement to achieve this, and noticing through observation is a basic and significant aspect in gathering the assessment data.

Assessments, accurate or inaccurate, lead to what is perceived as a problem or patient need and determine the plan of care. The understandings developed from the assessment drive the entire reasoning process! Noticing the realities of the physical burn may afford learners a deeper understanding of assessment and its implications for accurate clinical judgments.

Here are a few examples:

· The scalding burn is dramatic and its very appearance can challenge learners to consider the history of how the burn occurred.

o Learners may question whether the patient’s story makes sense. Students may wonder about possible abuse,

o Or whether some impairment, like substance abuse, was involved that may uncover additional patient needs beyond burn management.

· Seeing the extent of a burn may

o Alert learners regarding potential loss of function and the impact on the patient’s life after discharge.

o Trigger an emotional response, promoting fuller awareness of the impact on the patient with the burn injury that has patient-care implications.

Visualizing the burn provides the opportunity to explore the mechanism of injury, the story behind the event, and triggers insights regarding the patient’s broader picture. Simulation and realistic moulage provide the object for deep discussions to enhance assessment and reasoning skills so vital to the budding development of reasoning for clinical judgment!

Sara Manning, MS, RN, CHSE Coordinator of Clinical Simulation Education Assistant Professor of Nursing

NLN Simulation Leader Alum

Technique:

Remove a large amount (approximately 2 cc each) of Silifix Gel Set A & B in equal portions and place on palette board to activate. Using a palette knife, spread a thin layer (approximately 1/8" thick) of combined Silifix over the top of the hand, wrist, and areas of exposed flesh. Working quickly, blend the outer perimeter of the Silifix gel into skin. To blend: Using the flat edge of your utensil, smooth the perimeter of the Silifix edges outward, thinning the material and blending into the skin.

Quick Tip: To ensure long term integrity of Silifix products, use separate utensils to remove product from each container prior to combining on palette board (combination of products creates a chemical reaction that readies it for use- causing it to solidify.) Use separate instruments (palette knives or tongue depressors) when combining Silifix.

Working quickly, press stipple sponge into silifix, using a quick blotting technique to create texture. Continue to press sponge into silifix, creating texture and "pocking" marks until gel is firmly set.

"Degloss" the moulage surface. Using a makeup blush brush that has been dipped in translucent setting powder (gently tap edge of brush to container to release the excess powder) brush the surface of the Silifix until matte or no longer shiny. )

Using a small paint brush, paint along the edges of the silifix, where the natural skin meets the gel, using the "burn red" color.

Using a small paint brush, paint between the edges of the silifix, over the natural skin, and along the raised ridge of the silifix line, where the burn red meets the bright red colorant.

Apply blisters: Using a small amount of Silifix, adhere raised blisters along the skin line, over the darkest areas of color.

Cleanup and Storage

Carefully remove wound from simulators skin; using your fingers to lift the wound around the edges of the silifix. Using a gentle upward motion, continue to peel away the wound until all silifix has released from the skin. Using a soft clean cloth or make-up remover towel, remove the makeup and any remaining product residue from the skin per manufactures instructions. Allow shredded clothing to air dry before storing in moulage box for future use.

The information contained on this page does not and is not intended to convey medical advice and should be used for SIMULATED TRAINING purposes ONLY. Moulage Concepts and/or contributing authors are not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.

DISCLAIMER: By providing links to other sites, Moulage Concepts does not guarantee, approve, or endorse the information or products available on these sites. Please note that all opinions expressed by our contributors are their opinions and do not represent the company they work for. All content is owned by the blogger and therefore cannot be copied, distributed, or repurposed without prior consent.

___________________________________________________________________________

Bobbie Merica is a medical/trauma moulage expert, author and owner of Moulage Concepts Inc., an nationwide moulage company specializing in training, supplies and certification. Utilizing best practice techniques, Bobbie's teaching methods have simplified the complex, enabling everyone to create Moulage that is quick, cost effective and convincing. Get her free tutorial blog with expert weigh-in at www.moulageconcepts.com and join us in creating moulage that looks, feels, sounds, and even smells like the real thing!

Visit Moulage Concepts at www.moulageconcepts.com for all your moulage supplies,

Recipe are referenced from Emergency Moulage- Making Your Simulations Come Alive.

Author: Bobbie Merica, Published 2011

The recipes contained in this handout are for personal use only and is, unless otherwise stated, the property of Moulage Concepts. Copyright and other intellectual property laws protect these materials. Reproduction, re-transmission or any type of public display or teaching of these materials, in whole or in part, in any manner, regardless of monetary gain is a violation of copyright law Expert content remains the intellectual property of holder.