One of our Emergency Medicine Residency instructors wanted to do a pericarditis scenario and asked if I could do an Osler's Nodes moulage on the simulator. This is something I was unfamiliar with, so I looked it up and found they are small (the size of split peas), tender, transient nodules in the pads of fingers and toes and the palms and soles. They are a highly diagnostic sign of bacterial infection of the heart (subacute bacterial endocarditis). I'll post a photo from the ADAM Medical Encyclopedia that I used as a pattern and the steps I used to create the effect. It's far from perfect, but probably close enough to lead the learners in the right direction. This moulage would be much more effective on real skin. It's very hard to blend the colors around the borders of the wax on plastic skin, so you end of with a visible line. However, it's probably close enough to be representative of an appropriate finding.
I'm also working on a moulage of Janeway Lesions, a similar finding that's significant for infectious pericarditis, but caused by Staphylococcus aureus. Also, Osler Nodes are raised and painful, whereas the Janeway Lesions are flat and non-painful.
Osler Node: ﾠPhoto from the Adam Medical Dictionary (copyright)
Osler Node 01: Nose and Scar wax by Ben Nye. Form a small ball, between the size of a bee bee and a pea.
Osler Node 02: Apply a thin coat of Vaseline to the desired site.
Osler Node 03: Press the small wax ball onto the desired site.
Osler Node 04: Smooth the wax to form a bump on the skin. Pay extra attention to feathering the edges. The better you feather, the easier it is to blend the color.
Osler Node 05 & 06: Ben Nye Character Wheel WK-45 Special Effects. I used the red pigment from this item.
Osler Node 07: Dab a small amount of the red pigment to the wax and pat it lightly until it blends. I find it best to pat it lightly to feather it out, rather than rubbing it.
Osler Node 08 & 09: Ben Nye F/X Color Wheel CK-1 Bruises. I used the brown looking pigment from this item.
Osler Node 10: Dab just a tiny amount of the brown pigment to the wax.
Osler Node 11:ﾠPat it lightly to feather the pigment. This is a poor image, but you get the idea.
Osler Node 12: With a small paint brush, dab a small amount of the brown pigment in the center of the bump, if desired.
Osler Node 13: The same moulage effect applied to the side of the great toe.
Originally posted on SSiH forum Tricks of the Trade by Jimmy Rowland