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. Photo
Description: 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 http://www.ssih.org/SSIH/SSIH/eGroups/Message/Default.aspx?MID=456 |