Wound of the Month: MRSA

Objective: Using moulage to create realistic early-stage MRSA blisters. (see Figure 1.)

Time: 3-5 minutes

Skill Level: Intermediate

Supplies:  (Shop www.moulageconcepts.com for all your moulage needs)

• Dark red make-up, cake
• Light red make-up stix or colorant, cream
• Brown watercolor marker
• 2 drops red Moulage Gel
• 1 cc flesh-colored Moulage Gel
• White pearlescent eye shadow

Equipment:

• Blush brush
• Cotton swabs
• Make-up sponge
• Hotpot
• Thermometer
• Laminated board
• One 20-cc syringe with cap
• Small paintbrush
• Tissue

Technique:  (see Figure 2)

Heat the Moulage Gel to 140°F. On the laminated board, combine 1 cc of flesh-colored Moulage Gel with 2 drops of red Moulage Gel. Stir the gel thoroughly with the back of the palette knife to blend, creating a fleshy-pink color.

Allow mixture to set fully before pulling up and re-melting in 20-cc syringe. Reduce heating element on hotpot to 120°F. On the laminated board, place a drop of pink-red Gelefects, approximately ¼ inch or the size of a pencil eraser, and let sit approximately 3 minutes or until firmly set. Note: If you would like to add infectious material to the center of the blister, allow blister to set for 5-10 seconds and lightly puncture surface of blister using a toothpick to create a divot. (see Figure 3)

Using a red make-up stix or cream colorant, apply a medium-sized, approximately 3x3 inch circular pattern to the skin. While colorant is still moist, lightly blot color with a small paint brush or tissue along the outside perimeter, variegating the color intensity and softening the lines. Allow to set a few seconds until fully dry. (see Figure 4)

Set the cream make-up and extend the infection process by applying the cake make-up over the cream make-up. Dip the end of the blush brush applicator into red cake make-up and apply a medium-sized, approximately 4x4 inch circular pattern to the skin, applying over the cream colorant and extending outward toward the natural skin. Using the same applicator, create a thin line of color leading away from the site, upward toward the heart by a few inches. (see Figure 5)

Using a make-up sponge  or the end of your finger, gently blot the surface of the reddened skin area to soften the edges and blend into the natural skin. (see Figure 6)

Using a very small paintbrush or cotton swab, apply a small drop of white pearlescent eye shadow on the surface of the blister. (see Figure 7)

Depending on the stage of the MRSA and infectious process, apply a tiny brown dot to the center of the blister. (see Figure 8)

Using a cotton swab, gently blot surface of dot to soften exit point and create mottling.

Note: Blister is ready to accept infectious material. Using a small paint brush, apply a small amount of (thick) odor infectious drainage to the divot of the blister. 

Quick Fix:

MRSA blisters can be made in advance and stored covered in the freezer and reused indefinitely. Allow the blister to come to room temperature for at least 1 minute before proceeding to scenario.

Training Scenario:

Dispatch: Medic 12, respond Code 3 to 1022 Washington Street; unknown injuries. Nearest cross street, Ross Road. 1900 hrs. Dispatch clear.

On Scene: Using a small adult to simulate a 10 year-old, create pallor on face of victim. Using a make-up sponge, apply white makeup to the face of victim, blending well. Apply MRSA blister with infectious material to lower arm of victim. Create beads of sweat on the skin by applying a light mist of sweat mixture to the forehead, chin and upper lip of simulator. Place victim in bed sitting on the ground, near food prep station; place a large amount of blood on cutting board, work station and large knife. Advise patient to breathe rapidly, shake with the chills and show nausea with vomiting. When gathering patient history advise family member to share that the child was released from the hospital several days ago for care of pneumonia. 

Use in Conjunction With:

• Vomit
• Odorous drainage, thick
• Diarrhea
• Sweat

Cleanup and Storage:

Gently remove blister from skin of victim. Store blister on a waxed paper–covered cardboard wound tray. Wounds should be stored side-by-side, but they should not touch to avoid cross-color transference. Loosely wrap wound trays with plastic wrap and store flat in freezer. Using a soft, clean cloth or make-up remover towelette, remove the make-up and any remaining product residue from the skin. Vomitus-soaked garments can be air-dried and stored in 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 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. For more information, visit www.moulageconcepts.com.