Medical Monday; Agony of the Feet (infected plantar wart)

Time for another Medical Monday! And the obligatory trigger warning:

So this is Sim Man (well, ALS Man), one of our high-fidelity patient simulators. Or Slightly Sinister Robot-Man, if you prefer. We've started doing regular monthly Insitu training on Surgical post-op with this chap, and one of the scenarios we were asked to help with was dealing with an older patient with an infected foot wound. Essentially, a Plantar Wart (verruca, for you non-medical types) which had become infected and turned into an open, ulcerated wound.

Here's one I prepared earlier; this one on the heel of the foot. Used a spare foot from the odds and ends box, and a hole cut into the skin, an extra layer added on the inside, and then a soldering iron and hot-glue to mank-up the layer for some texture. The layer on the inside was quite thick (but it didn't matter, as it was going on a custom-designed mannequin). For this new model, apart from the fact the wound needed to be on the toe, the inner layer would need to be thinner to go over the plastic inner foot of the robot. 

Yeah, that thing in the bottom of the picture. It's curiously disturbing, isn't it? I don't think Sim Man is going to be getting much trade on his OnlyFans page with those toes.

The plan was to cut a hole in the base of the toe, then have an inner layer to use as the foundation for the wound. I initially tried using some spare 3mm-thick neck skins for the inner, but these were still a bit too thick for the foot to go over that plastic former...

...but I then found, in the materials cupboard, some more bits of a popped beach ball (having previously used the transparent red vinyl for making some simulated pooled blood). I was having trouble working it into the toe though, and pulling it into place from the inside. If only I had some sort of long forcep-like tool to pull it through from the inside...

Oh wait, that's right, I work in a lab full of more instruments than I can count.

The edge of the wound was chamfered and cut with a size-22 scalpel, then the vinyl was fitted in place, and the whole lot washed over with superglue and left to set.

Hot glue was used to make a border around the wound (to represent peeling flesh around the wound), and some slivers of the spare latex skin from the removed patch glued inside for texture . Once again, Warhammer paints used to colour it all...

...and fake blood washed over the wound, to give it a glossy look.

Raiding the make-up kit for reddening around the wound, and we also had some simulated pus to mix in before the wound was dressed.

Yeah, all it's missing is the rank smell (and we did indeed try to simulate that too).

And here he is, ready for the Sim. The wound was wrapped up and bandaged (as if the patient himself had done it), so it was a bit sticky and gunky when the examining candidate peeled the dressing off. Lovely stuff- and best of all, it's re-usable for future sims.

 

This month in BRM; A Night at the Movies

The sun has finally come out as I type this, the weather is Shirtsleeve-Order, and it's looking nice and Spring-like out there... so why not have a project done last Autumn to look like it was set on a gloomy, blustery evening?

The build was to modify and personalise a pair of Metcalfe Cinema kits. Two were combined into one, with the spare outer wings turned into this block of shops. Nod to my friend Ruthie on the left, who ran a cafe I was assistant-manager of back in the day, and my old local chippy in the West Mids.

Lighting was added, in slightly slapdash fashion (it wouldn't be massively visible and I was against the clock with this one as usual), using cheap battery Xmas lights.

Uplighters for the front of the building were made using a plastic container for pencil leads, which was a bit of an improvisation.

The real fun with this project came from doing the movie posters. Wary as ever of breaching copyright law, it was a chance to make a few of my own. The humans modelling for the posters are actually the robot-patients from work, the models are ones I've done for other projects, and the illustrations are characters I've done for comics. The interiors above are also the main reception at my job.

A bit of a mix of film genres! Arf and Woof seem to be starring in their own Kids series now. Move over Bluey... also, Hallie gets in on the act as well, now starring in her own movie, the little Diva.

Lightboxes from acrylic.

I was quite proud how this one turned out- I enjoyed adding details like the light-up premier board, and modern touches like the ramped access.

Another large diorama. I can't believe I had the intention to do all these on an A4-sized template back when I started...

The only problem I had was getting the lamp-posts to work; I couldn't get them functioning properly, so left them off, hopefully it doesn't stand out too much.

...and in the current issue.

Medical Monday; An Arm and a Leg

So it's been a while since the last Medical Monday... partly because it's been an (insanely) busy winter at work, and partly because we've done a lot of Obs and Gynae stuff, which I really, really, can't post on here because it is (insanely) rude. So how about some paediatrics?

Poor little Hallie, she's had a rough start to the year. My little robot-child (or my 'Work Daughter' as at least one of my family refer to her) has been through the wars, with a number of trauma sims. 

Oh and quick shout of appreciation for the makers of this stuff, these wound-effect makeup kits have really enabled me to raise my game with the fidelity of the sims. Still learning, of course, but these are just terrific, and won't stain the robots either, but don't come off on the trainee's hands. Except the blood, and the pus (more on that in the next Medical Monday. Something to look forward to eh?)

So, to start with, Hallie needed a broken arm. Basing this very much off real life with Younger Child, as two out of three of The Childs were Disaster Magnets in their youths, and a job made considerably easier here by Hallie having detachable arms.

The plan was to use the same broken-leg wound, with the grating-bones, made for the broken leg injury last year.

This one, as featured in an earlier instalment.  The trouble was, it was too big for her petite little arm, forcing me to need to build a new one. On top of which, the rubber bladder that gives it the toe-curling squishyness (medical term there) made it project up too much under the latex flesh.

Time to raid the bone box, for more fibreglass leftovers.

Once again, I was operating on a budget of roughly Sweet F-A, because NHS, so raided whatever I could to cobble something together. A base plate for...

...a set of plastic tweezers. The plan was, one arm (leg?) of the tweezers would be glued to the wooden knife, the bone inserted around the other leg, meaning it would be lightly sprung when you pushed down on the projecting bone. The whole lot secured to more vinyl, to wrap around the inside of the-

SNAP. Yeah exactly what you want after two wasted hours, and with only one night to go before the Insitu, with a dozen people counting on you pulling off a convincing effect.

So I turned instead to this- a sponge skin pad, for the squishiness factor. The bones were cut to shape then hot-glued to pieces of the foam.

Suitably cut-down, then attached with 3M tape, the do-all adhesive of the medical world.

Not the most sophisticated job, but...

...with the skin rolled back up, and a hell of a lot of wound make-up, it looked the part. 

So Hallie had been riding her bike, and had been catapulted off it by a D*ck in an Audi (how often those words are synonymous) who hadn't stopped. Poor girl had a broken arm, grazes all over her, but the real wound was internal bleeding from the handlebars thumping into her stomach. Also, given Sim is on the opposite side of the site and four-floors above the A&E Basement, you don't half get some puzzled looks strolling past everyone in the main entrance with this.

Look at her, the little Diva. "Oh, I love being on the stage, but I'm just exhausted, Darlings... wait, another Sim?!"

Yeah I probably should have warned people I'd run out of bed spaces, and sat her on a chair in the control room. Nearly gave two of my colleagues heart attacks, finding her sat there.

"Back to the stage, Darlings, for the next one"

So, anyway, CT3Pem; this one required the broken leg. Now, we've had trouble with that broken leg I made, in that whilst A&E have proper equipment, our Thomas Splint in the Sim Centre is old as God's dog, is too small, and won't quite fit over the break, so I needed to make a smaller one. Or rather, with next to no time to prep for it, re-use the Arm bones.

Same patented 3M Tape securing method.

Still, looked good.

But amused, she was not. Funny how her default expression when on is RBF.

Similar injuries to the arm break scenario; the real damage was her abdomen. Also note the battered plushie as well, which she was holding during the accident. Details, details, make the scenario.

"I swear, I need to call my agent. Wonder if there's opening for Robot Child No.3 at "It's A Small World?"

A happier Hallie, up on the whiteboard.