Wound of the Month: Blisters—Large, Blood-Filled and Rupturable

Time: 1 minute. See Figure 1.

Skill Level: Beginner

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

Latex, flesh-colored (transferred to a drip top bottle)

Single large bubble from bubble wrap sheet

Blood gel

Warm water

Equipment:

10cc syringe

22 gauge or smaller needle

Plastic foam cup or vessel

Scissors

Fork

Technique:

Using scissors, carefully remove the edges around the packing bubble, working carefully to ensure the integrity of the packing bubble remains intact. If the packing bubble structure deflates, you will need to start fresh.

In a plastic foam cup, mix together the warm water and blood gel. Using a fork, stir mixture thoroughly until blood gel has dissolved and water is tinted; draw the fluid into syringe and cap with a needle. See Figure 2.

Invert the packing bubble so it is face down. Gently place the syringe needle through the back side of the bubble and fill with it tinted water. See Figure 3.

Simultaneously remove the needle from the back of the packing bubble while placing a drop of liquid latex over the exit hole to seal it. Allow the droplet to set before applying a second drop of latex over the first, extending outward to ensure a full seal.

To create elongated blisters: Gently but firmly pull on either side of the packing bubble, elongating the ends. Pinch the stretched ends together along the bottom side and glue with latex or rubber cement prior to filling with fluid.

Quick Fix

Blisters of varying sizes, shapes and colors can be made in advance, stored in the refrigerator and reused indefinitely.

Dispatch

Medic 65, respond Code 3 Western Pacific Industries Lumber Mill; unknown injuries. 195 Pacific Coast Highway; nearest cross street, Billings Avenue. Mendocino police and fire responding. 0715 hours. Dispatch clear.

On Scene

Using a make-up sponge, apply white makeup to the face of victim, blending well along the hairline. Create beads of sweat on the skin by applying a light mist of premade sweat mixture to the forehead, chin and upper lip of the patient. Create industrial residue on victim’s clothing by using a large paint brush dipped in soot powder, liberally applying the powder to the front of the victim’s shirt and pant legs. Position the victim on the floor, flat on his or her back. Using rubber cement or latex, carefully attach large bloody blisters to the lower extremities and pelvis of the victim, underneath his or her clothes. Gently place large wood beams, steel rods and overturned machinery near and/or over the victim’s legs.

Use in conjunction with crush injuries, such as swollen and broken bones; bruise, fresh; bruise, 24 hour.

Helpful Hint

Moving patients without compromising their blisters is a “skill set,” and imperative to the patient’s care. To create blisters that will rupture with undue force, gently puncture the side of the blister with a (tiny) pin prick from a 25 gauge needle; any pressure will cause the blister to rupture.

Cleanup and Storage

Using a soft clean cloth or make-up remover towelette, wipe away the make-up and sweat from the skin of the victim. Carefully peel away the bloody blisters from the skin of the victim and store in the refrigerator on a cardboard sheet that has been wrapped in wax paper. Treated garments may be laundered or stored together in a sealed freezer bag in your moulage box for future use.

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 Gap^TM 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.