SMACCForce: E-CPR - Panel

•Als PPTX, PDF herunterladen•

1 gefällt mir•2,453 views

SMACC Conference

SMACCForce: E-CPR - Panel by Brian Burns, Paul Gowens, Lional Lamhaut, Steve Bernard, Nikki Stamp, Alice Hutin

Gesundheit & Medizin

Weitere ähnliche Inhalte

Mehr von SMACC Conference

Andrew Chow, Intensivist with a neurosurgical background, argues that the current categorisation system for traumatic brain injury (TBI) works, and makes sense! He tackles us through the history of this system, and why it’s important to differentiate different types of TBI. The arguments in favour of this categorisation include the consistency and benefits of a universal language, the implications for triage and management, and the fact that this system has been endorsed by all major organisations

TBI Debate - Mild, moderate and severe categories work

SMACC Conference

Dr Nick Little is an experienced Neurosurgeon who's looked after patients with traumatic brain injury for his whole career. Here he discusses the difficulties of prognostication following traumatic brain injury (TBI). He talks about the statistics of outcomes following mild, moderate and severe TBI and then goes on to tackle the harder topic of how we try to work out what an individual would want if they knew the spectrum of outcomes that they may face. The issues with the clinical examination findings we use to prognosticate are covered, as well as which imaging findings he finds most helpful. He also mentions the difficulties with current prognostic calculators.

TBI: when to stop and when to give time

SMACC Conference

Historically, when it came to brain injury, ketamine had a bad rap. Much of that dogma was dispelled in the last decade, and ketamine is now frequently used as an induction agent in acute brain injury, especially traumatic brain injury, due to it’s favorable effects on haemodynamics. However a new application of ketamine is now being explored - whether ketamine may be able to reduce secondary brain injury.

Ketamine in Brain Injury by Toby Jeffcote

SMACC Conference

20 million people around the world are living with a spinal cord injury (SCI). The medical issues they develop over the years differ to any other patient cohort. These complications include autonomic dysreflexia, management of pressure areas, specific infections, nuanced peri-operative care and highly specific issues such as baclofen pump management and syringomyelia Do look at the NeuroResus section on this and listen to Spinal Rehab Specialist Bonne Lee talk about this side of SCI care. Keywords SCI, spinal, spinal cord injury, autonomic dysreflexia, pressure areas, infection, peri-operative care, baclofen pump, syringomyelia, chronic SCI, spinal trauma, spinal rehab, incomplete SCI

Managing Complications of Chronic SCI by Bonne Lee

SMACC Conference

Tania is a neurologist and epileptologist with expertise in continuous EEG (cEEG) and status epilepticus (SE). This talk covers what a seizure is, what status is, including focal and generalised status epilepticus. So why do we do cEEGs for patients with suspected SE? To confirm the diagnosis To see if patient just post ictal or still seizing To establish that the clinical and electric seizures have stopped To see if burst suppression is achieved To exclude other differential diagnoses She makes a good argument for why cEEG is such an important tool in managing SE. In the questions after the talk, the issue of availability of cEEG in the Australian setting was discussed. Limited montage EEGs are discussed including their pros and cons.

EEG and Status Eplilepticus by Tania Farrar

SMACC Conference

Stuart Browne is a Neuro Rehab specialist from Sydney. These slides accompany a talk he gave at the Brian Symposium in 2023. He discusses what "severe disability" really means. Severe disability is more common than many realise - about 6% of the Australian population. Stuart discusses how health is more than simply physical recovery and how it is a multidimensional construct. He covers how permanent disability doesn't necessarily equate to a poor quality of life. He also discusses the long timespan of recovery, which is often much longer than appreciated. He specifically discusses "Locked-in Syndrome" and how the survivors have surprisingly positive self-reported health-related quality of life and well-being. Stuart also covers how severely disabled people face various forms of discrimination.

Browne Neuro symposium.pptx

SMACC Conference

Paediatric Stroke by Shree Basu

SMACC Conference

After spinal cord injury (SCI), there aren’t many interventions we have available that actually make a difference. Augmenting blood pressure to increase spinal cord perfusion pressure is an attractive concept that may improve neurological outcomes following SCI. We know that hypotension can make SCI worse. Clinical studies looking at blood pressure augmentation are mostly old, retrospective and flawed in various ways. Aiming for a MAP of > 85 for 5-7 days is recommended by guidelines but why this pressure and duration are good questions. Hypertensive therapy is relatively safe and easy to implement but not without risk. Tessa discusses the pros and cons, how this is managed practically and what the future may hold in this area.

Hypertensing Spinal Cord Injury - gold standard or wacky?

SMACC Conference

Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. He discusses the background to CPPopt, including intrcranial pressure (ICP), the Monroe Kelly hypothesis, neurovascular coupling, and cerebral autoregulation in health and following brain injury. He shows how intracranial pressure is affected by intracranial compliance and how this affects ICP waveforms. Cerebral perfusion pressure in relation to the Brain Trauma Foundation guidelines is covered including management of elevated ICP (EICP). The currently recommended tiered approach to managing cerebral perfusion pressure and EICP is mentioned citing recent guidelines. He uses a clinical case of a TBI to illustrate how the CPPopt can be ascertained and used to guide therapy, including the easy to perform “MAP Challenge”. Mark also describes the Pressure Reactivity Index (PRx) and how it can be used as a target for therapy. Finally, he covers the exciting results of the preliminary COGiTATE pilot study.

Optimal Cerebral Perfusion Pressure

SMACC Conference

The Power of Words - Death and Language.ppt

SMACC Conference

Appropriate use of antimicrobials is primarily a patient safety issue, and is the key aim of an effective antimicrobial stewardship program. We discuss the challenges in the management of a patient with sepsis, and how decision-making is usually done in the absence of effective diagnostics. Time dependent protocols and the knowledge that undertreatment of a patient with sepsis will lead to poor outcomes will lead to prescribing that may be driven by fear. Antimicrobial resistance is associated with over-use of antimicrobials but is usually not the immediate concern. Antimicrobial stewardship programs should work closely with sepsis teams to ensure that sepsis pathways are implemented across the whole hospital, and that key principles of judicious use are embedded within the clinical pathway.

Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin

SMACC Conference

Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources. However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task. Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome. Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models. There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases. We end with three brief vignettes which highlight the fraught nature of long term outcome prediction.

Brain injury outcomes and predictors

SMACC Conference

In this podcast, Claire discusses the role of clinician communication and its impact on acute pain management. Claire explains how pain management outcomes can be optimised by enhancing patient expectations of benefit via patient-provider communication. Firstly, what we say to patients matters. Secondly, how we say it also matters. Pain is a complex phenomenon and managing expectations of pain and people’s experience of empathy is crucial. As healthcare professionals, we see multiple patients and are often run off our feet, but, as the studies clearly demonstrate… communication matters. And it matters a lot in pain management. This presentation shares research demonstrating the impact of clinician communication. Specifically, this includes how clinicians' talk about pain and pain management. Claire discusses the importance of patients' experience of pain, the effectiveness of pain management and patients' treatment outcomes. From CodaZero Live, tune in to a fascinating discussion on the importance of communication. For more like this, head to https://codachange.org/podcasts/

The importance of communication in pain management

SMACC Conference

Brain Death History

SMACC Conference

Blood Gas Interpretation

SMACC Conference

Timing, Tribes and STEMI's

SMACC Conference

SMACCForce: LIVE EMS Nation Podcast - "Feeding the Flame"

SMACC Conference

Acts of violence against paramedics is disgraceful but not doing anything about it is much worse. From DAS SMACC, Craig Wylie speaks to us about violence against paramedics in South Africa. In the four years leading up to this talk in 2017, there were 250 attacks against paramedics. In a neighbourhood where there can be up to 100 gunshots in three hours, this almost shouldn’t be surprising. Craig tells a story where he was called out to an emergency where his colleagues were under attack. His first thought? Why didn’t they get a police escort? But in a low to middle income country, it is rarely that straightforward. Where there is a high crime rate and may only be two police vehicles on duty, it isn’t always as easy as waiting for a police escort. Additionally, if paramedics had to rely on police attending their emergencies, is this just introducing another barrier to care? Craig asks three simple questions: 1. Has our management failed our staff members? 2. Have we done enough that the paramedics that we employ can protect themselves? 3. Have we as an EMS system entirely lost the plot towards our paramedics and how we respond to patient emergencies? The solution? Craig suggests it is all in the training. Paramedics need to be trained to understand the situations, to have a strong action plan, to have an exit plan and to involve community leaders. The team need to be trained to understand how to protect themselves so that they can provide care, whilst also looking out for themselves. Tune into a talk from DAS SMACC on Violence against healthcare workers - Paramedics under siege. For more like this, head to our podcast page. #CodaPodcast

Violence against healthcare workers - Paramedics under siege

SMACC Conference

From DAS SMACC, Charles Larson and Andrew Beck discuss intubating sick kids - small holes, big problems. When intubating a critically ill child we fear that they are going to arrest on induction and we consider the skill required to intubate in difficult circumstances. The most important thing to remember is that we will never be so good that we won’t make mistakes. The greatest critical care physicians are those that have good skills but that are also able to identify what might go wrong. Understanding the risks and having a plan for when something goes wrong is crucial. Managing critically ill children is a difficult task. We must understand their physiology, have a plan for induction and have a plan for if things go wrong. Importantly, we need to consider that it takes several minutes for drugs to kick in for children. What matters more than what drug you give is how you give it. Children don’t follow recipes so nor should you. Furthermore, some golden rules in managing airways in children: 1. Simulation and training is key: We don’t want to be educating ourselves on our patients, particularly in rare scenarios. 2. We must know our equipment, know our limits and know our support systems. Being able to call down help early is priceless. 3. Assess, plan and communicate with the team. 4. Don’t repeat without change. Trying to put the same size tube down the same size hole will always lead to problems. 5. Training needs to be ongoing and skills need to be revisited. Confidence does not always equal competence. Charles Larson and Andrew Beck share stories of Paediatric intubation in high pressure scenarios. For more like this, head to our podcast page. #CodaPodcast

Paediatric intubation

SMACC Conference

Join Timo de Raad as he discusses the complexities of CPR in paediatric congenital cardiac disease. Timo introduces the listener to Emma, a 4-year-old cheerful and playful girl. Emma was born with hypoplastic left heart syndrome – a condition where the left side of the heart is poorly formed. As a result, the heart cannot support adequate circulation around the body. 5 out of 10 000 live births in the Netherlands have this congenital heart defect. Timo was there for Emma’s birth, and he was there for Emma’s death. Treatment of hypoplastic left heart syndrome is a palliative three stage repair. The first procedure is the Norwood – within the first two weeks. Subsequently the Glenn procedure is undertaken, and finally the Fontan. In this procedure the pulmonary artery and aorta are combined to create one outflow tract from the heart. In essence, this creates one functional ventricle. As a result, there is a change in the cardiac physiology. This changes the dynamics when considering resuscitation in these patients. In Fontan hearts cardiac output is dependent on the preload which in turn is dependent on how much blood flows through the lungs. Accordingly, spontaneous breathing is critical for these patients. Constriction of pulmonary veins make it difficult for blood to flow back to the heart. When dealing with cardiac arrest in these patients Timo suggests treating it the same as any resuscitation – utilising chest compressions and epinephrine (adrenaline). He does suggest one extra thing, that being abdominal compressions. Timo describes the technique he uses. He pushes between the belly button and sternum. He recommends pushing as hard as if you were palpating the liver. In trials on awake patients, there were no complaints of pain when using this technique. Additionally, Timo discusses the ratio of 1 to 1 chest to abdominal compressions during the resuscitation. In conclusion, resuscitation of a paediatric congenital heart defect is challenging. Consider the growing evidence base on abdominal compressions whilst acknowledging the differing opinions in this space. For more like this, head to our podcast page. #CodaPodcast

CPR in paediatric congenital cardiac disease

SMACC Conference

Mehr von SMACC Conference (20)

TBI Debate - Mild, moderate and severe categories work

TBI: when to stop and when to give time

Ketamine in Brain Injury by Toby Jeffcote

Managing Complications of Chronic SCI by Bonne Lee

EEG and Status Eplilepticus by Tania Farrar

Browne Neuro symposium.pptx

Paediatric Stroke by Shree Basu

Hypertensing Spinal Cord Injury - gold standard or wacky?

Optimal Cerebral Perfusion Pressure

The Power of Words - Death and Language.ppt

Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin

Brain injury outcomes and predictors

The importance of communication in pain management

Brain Death History

Blood Gas Interpretation

Timing, Tribes and STEMI's

SMACCForce: LIVE EMS Nation Podcast - "Feeding the Flame"

Violence against healthcare workers - Paramedics under siege

Paediatric intubation

CPR in paediatric congenital cardiac disease

Kürzlich hochgeladen

Ahmedabad Call Girls Book Now 8980367676 Top Class Ahmedabad Escort Service A...

Genuine Call Girls

Dr. Faiza delivers an insightful lecture on the distinguishing characteristics of skeletal, smooth, and cardiac muscles, offering a comprehensive understanding of their histology, physiological anatomy, electrophysiological properties, and contractile mechanisms. Through meticulous tabulation and comparison, she aims to equip learners with a detailed comprehension of the unique features and functionalities of each muscle type. Beginning with a detailed exploration of histological differences, Dr. Faiza outlines key distinctions such as multinucleation in skeletal muscle, mononucleation in smooth and cardiac muscles, and the presence of striations in skeletal and cardiac muscles. She meticulously elucidates the structural arrangement of each muscle type, highlighting their cellular morphology and organization within tissues. Transitioning to physiological anatomy, Dr. Faiza navigates through various aspects including innervation, level of control, initiation of contraction, and modification by hormones. By delineating the role of the somatic nervous system in skeletal muscle control, and contrasting it with the autonomic nervous system's influence on smooth and cardiac muscles, she offers a nuanced understanding of neural regulation in muscle physiology. Furthermore, Dr. Faiza delves into electrophysiological properties, elucidating the mechanisms underlying action potential generation, duration, and ionic basis in each muscle type. Through insightful analysis, she reveals how differences in action potential characteristics contribute to variations in muscle contraction speed, duration, and resistance to fatigue. Finally, Dr. Faiza meticulously examines the contractile mechanisms of skeletal, smooth, and cardiac muscles, shedding light on the sliding filament theory, mechanisms of calcium action, and speed of contraction. By comprehensively comparing these mechanisms, she provides learners with a deep understanding of the intricate processes governing muscle contraction and function. Through engaging presentation and meticulous analysis, Dr. Faiza's lecture serves as a valuable resource for students seeking a thorough understanding of the fundamental differences between skeletal, smooth, and cardiac muscles.

Difference Between Skeletal Smooth and Cardiac Muscles

MedicoseAcademics

Cheap Rate Call Girls Bangalore {9179660964} ❤️VVIP BEBO Call Girls in Bangalore Karnataka Booking Details Are here: just visit website: https://girlsinbangalore.com #Call Girl In Bangalore, #Bangalorecallgirls #CallgirlserviceBangalore, #CallgirlsinBangalore 12-May-2024( Mj) Click On WhatsApp Chat +91-9179660964 Bangalore Escorts Make You Feel Like Royalty Bangalore Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion

Cheap Rate Call Girls Bangalore {9179660964} ❤️VVIP BEBO Call Girls in Bangal...

Sheetaleventcompany

(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of High Profile Jaipur Call Girls | Party Escorts Booking Details Are here 05-May-2024(king) Click On WhatsApp Chat +91-8445551418 Jaipur Escorts Make You Feel Like Royalty Jaipur Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days!

(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of ...

TanyaAhuja34

Low Rate Call Girls Bangalore {9179660964} ❤️VVIP NISHA Call Girls in Bangalore Karnataka Booking Details Are here: just visit website: https://girlsinbangalore.com #Call Girl In Bangalore, #Bangalorecallgirls #CallgirlserviceBangalore, #CallgirlsinBangalore 11-May-2024( Mj) Click On WhatsApp Chat +91-9179660964 Bangalore Escorts Make You Feel Like Royalty Bangalore Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion

Low Cost Call Girls Bangalore {9179660964} ❤️VVIP NISHA Call Girls in Bangalo...

Sheetaleventcompany

❤️Chandigarh Escorts Service☎️8868886958☎️ Call Girl service in Chandigarh☎️ Chandigarh Call Girls Service ☎️ Call Girls In Chandigarh BEST Call Girls in CHANDIGARH Escort Service provide Cute Nice sweet and Sexy Models in beautiful CHANDIGARH city cash in hand to hand call girl in CHANDIGARH and CHANDIGARH escorts. HOT & SEXY MODELS // COLLEGE GIRLS IN CHANDIGARH AVAILABLE FOR COMPLETE ENJOYMENT WITH HIGH PROFILE INDIAN MODEL AVAILABLE HOTEL & HOME ★ SAFE AND SECURE HIGH CLASS SERVICE AFFORDABLE RATE ★ 100% SATISFACTION,UNLIMITED ENJOYMENT. ★ All Meetings are confidential and no information is provided to any one at any cost. ★ EXCLUSIVE Profiles Are Safe and Consensual with Most Limits Respected ★ Service Available In: - HOME & 24x7 :: 3 * 5 *7 *Star Hotel Service .In Call & Out call Services : ★ A-Level (5 star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob)Receive advanced sexual techniques in different mode make their life more pleasurable. ★ Spending time in hotel rooms ★ BJ (Blowjob Without a Condom) ★ Completion (Oral to completion) ★ Covered (Covered blowjob Without a Condom)Chandigarh Call Girls

💚Reliable Call Girls Chandigarh 💯Niamh 📲🔝8868886958🔝Call Girl In Chandigarh N...

Sheetaleventcompany

ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx

Swetaba Besh

7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta

Lifecare Centre

Pune Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Pune No💰Advance Cash On Delivery Service Booking Details Are here: just visit website: https://hotbabe24.com #Call Girl In Pune, #Punecallgirls #CallgirlservicePune, #CallgirlsinPune Website on rent : mailto:indiancallgirl4rent@gmail.com "Call Girls Pune VIP Call Girls Service Pune.. Booking Open Now We Are Providing Safe & Secure High Class girl women sucking men Services Affordable Rate 100% Satisfaction, Unlimited Enjoyment. Any Time for Model/ women seeking men in royal call girl High class luxury and premium call girl agency. ✔️High class luxury and premium escorts agency We Provide Well Educated, Royal Class Female, High-class Escorts agency offering a top high class escort service in the royal Escorts ✔️ Get High Profile queens , Well Educated , Good Looking , Full Cooperative Model Services. you can see me at my comfortable Hotels or I can visit you in hotel Our Service Available IN All Services 3/5/7 Star Hotels, In call /Out call Service 24/7.. ✔️ All Meetings We Provide Hottest Female With Me Are Safe And Consensual With Most Limits Respected Complete Satisfaction Guaranteed...Service Available In:- 24/7 3 * 5 *7 *Star Hotel Service In. In Call Out call service Avilable also. ✔️ I guarantee you to have an unforgettable experience with me A curvy body, long hair and silky smooth skin. She is an independent royal Escorts/Women Seeking Men model will give you more pleasure & Full satisfaction. ✔️ I am very sensual and flirtatious with charming personality! I love to laugh and my bright smile is ever Present. ,Hotel & Home Services CALL PLZZ ✔️Available Near All 3* 4* 5* 7* Hotels Of I Want Only Hotel Name , Guest Name , Room No. Only For Confirmation.✔️ Nandani... agency...⭐⭐⭐⭐⭐ VIP...Service ✣ ✤ ✥ ✦ TIME WASTERS AND BARGAINERS ARE PLEASE EXCUSE, WE RESPECT YOUR SAFETY AND PRIVACY AND EXPECT TH WHATSAPP: 9xx000xx09 CALL ME" 9xx000xx09

Pune Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Pune No💰Adva...

Sheetaleventcompany

Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Service Available Call Mrs Leela Ji +91-8005736733 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in Kolkata Our place Which Is Very Clean Hygienic 100% safe Accommodation. Out-Call: — Service for Out Call You have To Come Pick The Girl From My Place We Also Provide Door-Step Services Hygienic: — Full Ac Neat And Clean Rooms Available In Hotel 24 * 7 Hrs In Kolkata C010524HD Our Services and Rates: – One Shot — 2500/in call (time ½ hour), 5000/out call Two shot with one girl — 5000/in call (time 1 hour), 6000/out call Body to body massage with sex- 3000/in call (time 1 hour) full night for one person– 8000/in call, 10000/out call (shot limit 4 shot) We are available 24*7 all days of the year Call us — 8005736733 !! Thank you for Visiting.

Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...

Namrata Singh

Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...

Cara Menggugurkan Kandungan 087776558899

Call Girls Rishikesh Just Call 8250077686 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Rishikesh Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Rishikesh Escorts are regular companions of elite gentlemen and can take them places they could only dream of visiting. These ladies take great care in maintaining themselves to look appealing; visiting salons and spas regularly keeps them looking their best; their portfolios can be found online via an escort’s agency website. EXCITING OPTIONS AVAILABLE AT OUR INDEPENDENT ESCORTS Candlelight dinner Evening date Night clubs or parties Hotels or your flats Business trip Business party Stripping party Rishikesh Escort Service are adept at performing wild anal sex, deep throat sex and cum eating - perfect for satisfying all your sexual needs and playing any game imaginable. Affordable professional assistants are readily available and ready to assist with any situation - be it romantic date or solo night. Their beautiful appearances and striking personalities will leave you speechless, while they can accompany you to restaurants or bars where their presence will surely leave an impression.

Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available

perfect solution

Dehradun Call Girl Service ❤️🍑 8854095900 👄🫦Independent Escort Service Dehradun WhatsApp Chat: ☎️ +91-8854095900 Call Girls Dehradun offer you everything from intimate moments to wild nights - be it intimate or wild. Their girls are always prepared to meet all your needs and desires so you're assured a memorable experience with them. Beautiful Babes are sure to turn heads wherever they go, captivating men with their seductive personalities and captivating looks - not to mention their sensually alluring bodies that are sure to satisfy all your naughty fantasies, from blowjobs to anal massages; not forgetting BDSM and orgies as well. Show them some appreciation when the time is right. Call Girl Dehradun that their clients can be very demanding. To maintain their reputation and gain more clients, these sexy call girls always work tirelessly to provide exceptional service that ensures each customer's happiness - so much so that many men seek them out to have an unforgettable experience with Passionate about providing erotic pleasure for their clients - fulfilling all sexy fantasies while offering role play services such as BDSM. ★OUR BEST SERVICES: - FOR BOOKING ★ A-Level (5-star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob) ★ Spending time in my rooms ★ BJ (Blowjob Without a Condom) ★. Extra ball (Have ride many times) ☛ ☛ ☛ ✔✔ secure✔✔ 100% safe WHATSAPP CALL ME💥✨✨⭐⭐⚡💦💦💨🔥💫💫 Their services range from erotic encounters and movie dates to in-call and out-call services, making this option available 24/7. Available for services including NSA, threesomes and foursomes sessions as well as massage services and casual foreplay - they even provide real girlfriend experience. Find one online or visit local women's clubs, hotels or restaurants. Hiring a Dehradun call girl for an evening or day out can be the perfect addition to your social gathering or office event, or you could arrange for her to visit your home or hotel room. Not only are these women gorgeous, they're intelligent as well, with great senses of humor - sure to please and leave you wanting more. If you want a cheap escort in Dehradun, look for someone who is either a student or works part time so that she will always be available when you need her. In addition to this, look for housewives as this ensures they have stable lives that can keep you satisfied for extended periods. These beautiful ladies will capture your attention at first sight with stunning eyes and full, seductive lips; not to mention a seductive personality that makes you want to spend more time with them; moreover they are discreet enough to meet up anywhere nearby! Hiring a call girl in Dehradun can be done through either the internet or calling her directly, with services like massage or sex sessions offered to request from specific agencies within a few hours of making contact. Furthermore, text the girl directly for price quotes!

Premium Call Girls Dehradun {8854095900} ❤️VVIP ANJU Call Girls in Dehradun U...

Sheetaleventcompany

❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ Chandigarh Call Girls Service ☎️ Call Girls In Chandigarh BEST Call Girls in CHANDIGARH Escort Service provide Cute Nice sweet and Sexy Models in beautiful CHANDIGARH city cash in hand to hand call girl in CHANDIGARH and CHANDIGARH escorts. HOT & SEXY MODELS // COLLEGE GIRLS IN CHANDIGARH AVAILABLE FOR COMPLETE ENJOYMENT WITH HIGH PROFILE INDIAN MODEL AVAILABLE HOTEL & HOME ★ SAFE AND SECURE HIGH CLASS SERVICE AFFORDABLE RATE ★ 100% SATISFACTION,UNLIMITED ENJOYMENT. ★ All Meetings are confidential and no information is provided to any one at any cost. ★ EXCLUSIVE Profiles Are Safe and Consensual with Most Limits Respected ★ Service Available In: - HOME & 24x7 :: 3 * 5 *7 *Star Hotel Service .In Call & Out call Services : ★ A-Level (5 star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob)Receive advanced sexual techniques in different mode make their life more pleasurable. ★ Spending time in hotel rooms ★ BJ (Blowjob Without a Condom) ★ Completion (Oral to completion) ★ Covered (Covered blowjob Without a Condom)Chandigarh Call Girls

❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...

Sheetaleventcompany

Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Available 24*7 Book Chat On WhatsApp: +91-📞 7427069034 📞 Book A Meeting Now With Our Call Girls Chennai Call Girls Chennai are available for any special event from birthday parties to romantic dinners, and provide an unforgettable experience that will have you wanting more. Their seductive presence will leave you wanting more; these air hostesses escorts are guaranteed to get your kink on and provide hours of sexual fun - they will become your personal fantasy girl; making every event that much better. They truly stand out as some of the finest professionals available; their services cannot be rivalled. Call Now :- 📞 7427069034 📞 Independent Call Girls Chennai dance will leave #N06 you breathless with breathtaking performances that'll take away all your worries while making you feel like royalty - they're sure to leave an impactful impression that leaves you feeling empowered. From providing you with a romantic date night full of excitement and sex to just hanging out and talking, they're there for whatever it is you require. Listening attentively as you share stories or telling theirs, these ladies provide great conversation as well as delicious dinner or beverages to remember the experience by. Just one encounter with Call girls in Chennai will have you calling back for more. They're sure to transform any party into an unforgettable night of fun and adventure - you won't be the only one smitten. Don't miss this chance; arrange your next date with an exotic Foreign Escort today. Chennai offers many beautiful call girls Not only are they enjoyable companions, but travelling is something they truly love to do and will happily go on weekend tours with you. Additionally, businessmen can hire one of these young ladies as an escort during business trips. ★OUR BEST SERVICES: - FOR BOOKING ★ A-Level (5-star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob) ★ Spending time in my rooms ★ BJ (Blowjob Without a Condom) ★ COF (Come on Face) ★ Completion ★ (Oral to completion) noncovered ★ Special Massage ★ O-Level (Oral) ★ Blow Job; ★ Oral fun uncovered) ★ COB (Come on Body) ★. Extra ball (Have ride many times) ☛ ☛ ☛ ✔✔ secure✔✔ 100% safe

Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Availab...

amritaverma53

Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now CALL WATTSAPP 6378878445 THE MOST BEAUTIFUL INDEPENDENT ESCORT CALL GIRL SERVICE, Chennai WE ARE PROVIDING GENUINE CALL GIRL SERVICE I AM A a NATURAL BRUNETTES, SLIM BODY, NATURAL LONG HAIR AND ALL TYPE OF HAIR IS A NATURAL BRUNETTE IN THE MOST BEAUTIFUL INDEPENDENT ESCORT GIRL I AM A NATURAL BRUNETTE WITH ROOM AND HOTEL AND A NATURAL BRUNETTE WITH A BODY MADE FOR SIN AND ALL TYPE OF ME ALL THE TIME I SEND YOU A HAIR, VERY SOCIABLE AND FUNNY, READY TO ENTERTAIN TO ENTERTAIN U AND MAKE FORGET ABOUT TO GET ENTERTAIN U AND MAKE FORGET#v08 ABOUT ALL THE PROBLEMS. LET'S HAVE A WONDERFUL TIME TOGETHER AND FORGET ABOUT EVERYTHING ALL TYPE SERVICE ENJOYMENT SAFE AND SECURE IN CALL OUT CALL HOME AND HOTEL ANYTIME AVAILABLE AND ALL TYPE SERVICE ENJOYMENT

Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now

tanudubay92

💚Chandigarh Call Girls Service 💯Piya 📲🔝8868886958🔝Call Girls In Chandigarh No💰Advance Cash On Delivery Service Chandigarh Call Girls Service punjab ❤️🍑 📲Lucky 8868886958📲 💚👄🫦 Independent Escort Service Chandigarh Call Now :- 8868886958 Lucky Call Girl In Chandigarh | Chandigarh Call Girl | Call girl service in Chandigarh | Call Girls In Chandigarh | Chandigarh Call Girls Their services range from erotic encounters and movie dates to in-call and out-call services, making this option available 24/7. Available for services including NSA, threesomes and foursomes sessions as well as massage services and casual foreplay - they even provide real girlfriend experience. Find one online or visit local women's clubs, hotels or restaurants. Hiring a Chandigarh call girl for an evening or day out can be the perfect addition to your social gathering or office event, or you could arrange for her to visit your home or hotel room. Not only are these women gorgeous, they're intelligent as well, with great senses of humor - sure to please and leave you wanting more. If you want a cheap escort in Chandigarh, look for someone who is either a student or works part time so that she will always be available when you need her. In addition to this, look for housewives as this ensures they have stable lives that can keep you satisfied for extended periods. These beautiful ladies will capture your attention at first sight with stunning eyes and full, seductive lips; not to mention a seductive personality that makes you want to spend more time with them; moreover they are discreet enough to meet up anywhere nearby! Hiring a call girl in Chandigarh can be done through either the internet or calling her directly, with services like massage or sex sessions offered to request from specific agencies within a few hours of making contact. Furthermore, text the girl directly for price quotes!

💚Chandigarh Call Girls Service 💯Piya 📲🔝8868886958🔝Call Girls In Chandigarh No...

Sheetaleventcompany

❤️Chandigarh Escorts Service☎️9809698092☎️ Call Girl service in Chandigarh☎️ Chandigarh Call Girls Service ☎️ Call Girls In Chandigarh BEST Call Girls in CHANDIGARH Escort Service provide Cute Nice sweet and Sexy Models in beautiful CHANDIGARH city cash in hand to hand call girl in CHANDIGARH and CHANDIGARH escorts. HOT & SEXY MODELS // COLLEGE GIRLS IN CHANDIGARH AVAILABLE FOR COMPLETE ENJOYMENT WITH HIGH PROFILE INDIAN MODEL AVAILABLE HOTEL & HOME ★ SAFE AND SECURE HIGH CLASS SERVICE AFFORDABLE RATE ★ 100% SATISFACTION,UNLIMITED ENJOYMENT. ★ All Meetings are confidential and no information is provided to any one at any cost. ★ EXCLUSIVE Profiles Are Safe and Consensual with Most Limits Respected ★ Service Available In: - HOME & 24x7 :: 3 * 5 *7 *Star Hotel Service .In Call & Out call Services : ★ A-Level (5 star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob)Receive advanced sexual techniques in different mode make their life more pleasurable. ★ Spending time in hotel rooms ★ BJ (Blowjob Without a Condom) ★ Completion (Oral to completion) ★ Covered (Covered blowjob Without a Condom)Chandigarh Call Girls

Call Girl In Chandigarh 📞9809698092📞 Just📲 Call Inaaya Chandigarh Call Girls ...

Sheetaleventcompany

Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available WhatsApp Chat : +91-8854095900 Get More Information About Mussoorie Escorts Service Mussoorie Escorts offer their services to their clients at any time of day or night - including sex, travel and tours. Contact them via telephone or the internet. Hire an escort as your movie partner, date or party companion - they're sure to exceed all your expectations. Girls available 24/7 make for great companions who offer sensual body massages and drinks/food service during your time together. Find one who fits with your personality or budget - these girls have you covered.

Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available

Janvi Singh

In this lecture on circulatory shock, Dr. Faiza, an Assistant Professor of Physiology, delves into the profound implications of inadequate blood flow throughout the body, leading to tissue damage. The session begins by defining circulatory shock and elucidating its physiological causes, including decreased cardiac output, diminished blood volume, decreased vascular tone, obstruction to blood flow, excess metabolic rate, and abnormal perfusion patterns. Dr. Faiza categorizes shock into various types, such as cardiogenic shock, hypovolemic shock, neurogenic shock, obstructive shock, anaphylactic shock, and septic shock, and explores the pathophysiological basis of each. Furthermore, the lecture examines the stages of shock, from the non-progressive phase where compensatory mechanisms aim for full recovery to the progressive phase where shock worsens steadily without intervention, potentially leading to irreversible damage. Dr. Faiza discusses therapeutic interventions for shock, including replacement therapy, blood and plasma transfusion, sympathomimetic drugs, and other adjunctive treatments like head-down positioning, oxygen therapy, and glucocorticoids.

Circulatory Shock, types and stages, compensatory mechanisms

MedicoseAcademics

Kürzlich hochgeladen (20)