I am an academic EM physician with a niche interest in simulation.  Recently there was a request for collaboration on the Emergency Medicine section of the Society for Simulation in Healthcare listserv that caught my eye.

Colleagues: Do you have any good recipes for fake vomit?

Do I? DO I?  How many of you have developed a custom rig for making an airway training head vomit, created a recipe for fake emesis with excellent face validity AND gotten it published in a peer review journal. You haven’t, huh? Guess who has: Dr. Jessie Nelson, that’s who!

Hands down, this was my favorite foray into medical research. Most likely I enjoyed it because I had lots and lots of help. My co-conspirators had so much experience in EMS and research. But I brought the meat to the table on this study, and by that I literally mean the meat. Our goal was to compare a whole bunch of different airway devices used by emergency physicians and paramedics in a simulated difficult airway scenario. I was the simulation expert, hence my responsibility, no, my mission, was to create the best damn difficult airway I could.

I took my job very seriously.

First, I had to create a rig for getting vomit from one mildly sadistic researcher (me) to another room and up the esophagus of the airway trainer being intubated by my poor unsuspecting research subjects.  One trip to a hardware store to buy tubing, plumbing connectors and a hand siphon and that mission was accomplished.

Then came the tough part. I needed realistic looking vomit that was inexpensive, easy to make, could flow through the tubing and block or fog up video laryngoscopes. This was pre-Pinterest, so I was on my own.

Most important was the look. I started with instant oatmeal.  Biege, a little chunky or a little runny, depending on the need. Gets soupy quickly in hot water. Hot water is key because I needed the final product to be body temperature in order to fog up the screen.

But the color wasn’t right. Often we vomit before the stomach has had a chance to completely homogenize the meal. It needed a little something to give it a little…punch. A generic can of mixed vegetables did the trick.

We chew our food and the stomach works the contents a bit. A quick buzz with my immersion blender was perfect for adding some color to the oatmeal but still leaving some recognizable veggie chunks. The look was done.

But it still wasn’t right. I needed to make this as realistic a disastrous airway as I could. My reputation as a simulation fellowship trained physician depended on it. I wanted to really “squeeze the adrenals” of the research subjects. I needed the sensory inputs just right. It just didn’t smell like ED vomit.

Cheap beer to the rescue. Seriously, the most generic, terrible, cheapest beer you can find. I found American Adjunct Lagers to be my go-to beer category. One sad day I hadn’t planned ahead and needed to use a Belgian from my home fridge. Just wasn’t the same. Anyway, the waft of cheap lager took this fake vomit over the top. Seasoned physicians and paramedics actually burped a little. I was so proud.

Please take a look at our final product:

And that, my friends, is my biggest contribution to medical knowledge, and how I learned that research can be fun.

That was so fun and satisfying that I feel guilty keeping it to myself. I should share this joy. Can you do it better than me? What better way to find out than a cook-off.  I propose the First Annual SAEM Simulation Academy Fake Body Fluid Cook-Off.  Gather your residency and make your perfect regional concoction. Or compete on your own. We could have different categories.

• Blood
• Guts
• Gore NOS

Yeah, yeah, yeah, simulationists out there are making recipes all the time now (example 1, example 2, example 3, and example 4). But who best to judge this contest than a whole bunch of Emergency Physicians (wait, I know, Emergency Nurses).

Meet me in New Orleans with your slow cookers, immersion blenders and generic ingredients. Who’s with me?

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