Brazil - Timing, Tribes and STEMI's

•Download as PPTX, PDF•

2 likes•3,578 views

Vic Brazil opens smaccGOLD with a powerful insight into how conflict between "tribes" in our everyday working environment can adversely impact upon patient care.

Health & Medicine Travel

As a DEM specialist [DEMC4] describes, this facilitates
the emergence of ingroup solidarity:
“…and if we constantly feel in a state of siege of us
against everyone we’re trying to refer to,…….I think
everyone likes to have a little team allegiance.. And
having a common enemy is a really great bonding
experience for a team..”

Relationship
Goal
avoid
assertive
compromise

- power, popularity and the patient ‘trump card’…

‘Walk the walk’ with our trainees/ juniors
Balance the risks of conflict

Build relationships wherever we can
Balance the risks of conflict

the language revolves around infinite potential and
how the group is going to make history..
…….not to beat a competitor… but because doing so
will make a global impact….
…..this group is

Build relationships wherever we can
‘Walk the walk’ with our trainees/ juniors

Viewers also liked

CPR That Saves Lives

Salim Rezaie

1455 wilson 15

SMACC Conference

Deirdre talks ‘bad blood’ – the complex world of critical care haematology. Critically ill patients frequently have activation of inflammatory and clotting pathways. These are likely adaptive responses in the human. When they run riot, or the fine balance between pro- and anti-inflammatory states is shifted, there can be significant morbidity and mortality. Deirdre presents three patients to highlight these issues and what you can do about it. This acronym-busting talk will focus on some acquired haematological disorders in critically ill patients. Platelets make up a tiny percentage of blood – just 0.01%. However, they have a crucial role to play. A low platelet count can be due to reduced production or increased destruction. Disseminated Intravascular Coagulation (DIC) is a clinical and laboratory diagnosis that affects about 1% of hospitalised patients. At the most severe end it is associated with bleeding and/or thrombotic complications. Disorders such as thrombotic thrombocytopenia purpura (TTP) and other forms of micro-angiopathic haemolytic anaemia (MAHA) will also be described including the role of ADAMST13. The knowledge of what is what, is critical, as it will dictate treatment. Heparin-Induced Thrombocytopaenia (HIT) is an uncommon but important condition which is difficult to diagnose in a critically ill patient. It is a heparin dependent pro-thrombotic disorder. There is no good test for HIT. Have you always wondered about NETs (neutrophil extracellular traps) and their importance? If so this whistle-stop tour of non-malignant hematology in the ICU is for you! Deirdre drives home the message that low platelets are common in the critically ill and the causes are multifactorial. Finally, for more like this head to our podcast page. #CodaPodcast

Critical Care Haematology

SMACC Conference

Laerdal SUN Social Learning

Jesse Spurr

This is a lecture by Dr. Frank Madore from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.

GEMC: Meningitis and Other CNS Infections: Resident Training

Open.Michigan

Hacking medical education 20150604

precordialthump

Becoming competent in airway management requires good decision making and and technical skills. Ultimately what matters is how your clinical performance impacts patient outcomes. For this we need to have a clear understanding of what defines success ensuring that its more than just 'getting the tube'. Come to this talk and you'll experience a Canadian take on Guinness, adventure sports, flying a plane and how other factors including failure influence airway management outcomes.

Anyone Can Intubate, or Not: Teaching airway skills the antifragile way

SMACC Conference

Burns Airway Management by Gatward

SMACC Conference

Le Cong: Airway Clean Kills

SMACC Conference

Advanced Airway Management

Mario Rugna

SMACC: Parr on Trauma Performance: How good can you get?

SMACC Conference

Stuart Lane on prognostication post out of hospital cardiac arrest

SMACC Conference

Forget ACLS Guidelines when dealing with PEA. Part1.

Mario Rugna

Resuscitation Technology

David Hiltz

Foam in review

Kane Guthrie

YOUR Medical Education 2.0

David Marcus

Sdc smacc educational leadership and subversion copy

Simon Carley

PHARM in Review 2013

SMACC Conference

Myburgh, John — Raised ICP: Keeping a Lid on It

SMACC Conference

Prehospital CRM – Maximal Simultaneous Activity with Minimal Bandwith

SMACC Conference

Viewers also liked (20)

CPR That Saves Lives

1455 wilson 15

Critical Care Haematology

Laerdal SUN Social Learning

GEMC: Meningitis and Other CNS Infections: Resident Training

Hacking medical education 20150604

Anyone Can Intubate, or Not: Teaching airway skills the antifragile way

Burns Airway Management by Gatward

Le Cong: Airway Clean Kills

Advanced Airway Management

SMACC: Parr on Trauma Performance: How good can you get?

Stuart Lane on prognostication post out of hospital cardiac arrest

Forget ACLS Guidelines when dealing with PEA. Part1.

Resuscitation Technology

Foam in review

YOUR Medical Education 2.0

Sdc smacc educational leadership and subversion copy

PHARM in Review 2013

Myburgh, John — Raised ICP: Keeping a Lid on It

Prehospital CRM – Maximal Simultaneous Activity with Minimal Bandwith

More from SMACC Conference

Precision Medicine in Acute Brain Injury

SMACC Conference

CORTICAL SPREADING DEPOLARISATION IN NEUROLOGICAL DISEASE – AN INTRODUCTION By Toby Jeffcote Cortical spreading depolarization (CSD) is a spreading loss of ion homeostasis, altered vascular response, change in synaptic architecture, and subsequent depression in electrical activity following an inciting neurological injury. It was first described by Leão in 1944, a disturbance in neuronal electrophysiology has since been demonstrated in a number of animal studies, and recently a few human studies that examine the occurrence of this depolarizing phenomenon in the setting of a variety of pathological states, including migraines, cerebrovascular accidents, epilepsy, intracranial hemorrhages, and traumatic brain injuries. The onset of CSD has been demonstrated experimentally following a disruption in the neuronal environment leading to glutamate-induced toxicity. This initial event leads to pathological changes in the activity of ion channels that maintain membrane potential. Recovery mechanisms such as sodium-potassium pumps that aim to restore homeostasis fail, leading to osmolar shifts of fluid, swelling of the neuron, and ultimately a measurable depression in cortical activity that spreads in the order of millimeters per minute. Equally important is the resulting change in vascular response. In healthy tissue, increased electrical activity is coupled with release of vasodilatory factors such as nitric oxide and arachidonic acid metabolites that increase local blood flow to meet increased energy expenditure. In damaged tissue, not only is the restorative vascular response lacking but a vasoconstrictive response is promoted and the ischemia that follows adds to the severity of the initial injury. Tissue threatened by this ischemic response is then at elevated risk for CSD propagation and falls into a vicious cycle of electrical and hemodynamic disturbance. Efforts have been made to halt this spreading cortical depression using N-methyl-D-aspartate receptor antagonists and other ion channel blockers to minimize the damaging effects of CSD that can persist long after the triggering insult.

CSD by Jeffcote Coda 22.pdf

SMACC Conference

Subdural Haemorrhage and MMA embolisation

SMACC Conference

Andy Neill - More neuroanatomy pearls for neurocritical care

SMACC Conference

Andrew Udy talks about Brain Tissue Oxygen Monitoring: It’s Not What You’ve Got It’s What You Do With It The BONANZA Trial Andrew Udy talks about the ongoing BONANZA Trial which is assessing whether an algorithm that incorporates both ICP and brain tissue oxygen (PbTO2) can improve outcomes after traumatic brain injury (TBI). Like with all monitoring, how the PbTO2 is interpreted and managed is critical and the devil is in the detail! More on BONANZA here More on BOOST3 here

The BONANZA Trial and PbTO2 Monitoring

SMACC Conference

Dilating the Dogma of Vasospasm

SMACC Conference

EVD Tips and Tricks

SMACC Conference

Part 2 of a debate over the classification of TBI. Andrew Udy then argues that this classification is fundamentally flawed. He discusses the issues with the Glasgow Coma Scale, and therefore the follow-on issues in TBI classification, including all the confounders to the GCS, the issues with timing of the score as well as GCS not taking baseline function or specifics subtypes of TBI into account. He makes teh argument that biomarkers may better categorise the diffuse entity we call TBI.

There is no such thing as mild, moderate and severe TBI - by Andrew Udy

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

More from SMACC Conference (20)

Precision Medicine in Acute Brain Injury

CSD by Jeffcote Coda 22.pdf

Subdural Haemorrhage and MMA embolisation

Andy Neill - More neuroanatomy pearls for neurocritical care

The BONANZA Trial and PbTO2 Monitoring

Dilating the Dogma of Vasospasm

EVD Tips and Tricks

There is no such thing as mild, moderate and severe TBI - by Andrew Udy

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

Recently uploaded

8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad

GENUINE ESCORT AGENCY

Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Rajasthan Booking Details Are here 05-May-2024( Mj) Click On WhatsApp Chat +91-9521753030 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! 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

Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...

khalifaescort01

Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Massage and Pleasant Why you Choose Us- +91-6378878445 Bangalore Escort Service includes providing maximum physical satisfaction to their clients as well as engaging conversation that keeps your time enjoyable and entertaining. Plus they look fabulously elegant; making an impressionable I Have Extremely Beautiful Broad Minded Cute Sexy & Hot Call Girls and Escorts, We Are Located in 3* 4* 5* Hotels. Safe & Secure High Class Services Affordable Rate 100% Satisfaction, Unlimited Enjoyment. Any Time for Model/Teens Escort in Delhi High class luxury and premium escorts agency. CALL US High Class Luxury and Premium Escort Service We Provide Well Educated,Royal Class Female,High-Class Escort Service Offering a Top High Class Escort Service In The & Several Nearby All Places of $L16

Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...

tanya dube

Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Rajasthan Booking Details Are here 05-May-2024( Mj) 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! 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

Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...

parulsinha

Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine Escort Service & Hotel Service Available Call Mr Chirag Ji +91-7427069034 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, 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 Chennai 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 Chennai 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 — 7427069034 !! Thank you for Visiting.

Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...

hotbabesbook

Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 Star Hotel Service Available Booking Contact Details WhatsApp Chat: +91-8617370543 Patna Escort Service includes providing maximum physical satisfaction to their clients as well as engaging conversation that keeps your time enjoyable and entertaining. Plus they look fabulously elegant; making an impressionable Independent Escorts Patna understands the value of confidentiality and discretion - they will go the extra mile to meet your needs. Simply contact them via text messaging or through their online profiles; they'd be more than delighted to accommodate any request or arrange a romantic date or fun-filled night together. We provide - Flexibility Choices and options Lists of many beauty fantasies Turn your dream into reality Perfect companionship Cheap and convenient In-call and Out-call services And many more.

Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...

Dipal Arora

Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night girls hear seeking Navi Mumbai Escorts I’m sweet , warm , beautiful and friendly, independent escort girl. My body is sexy and natural. All my pictures are recent and real. InCall and outcalls as well offer class and good service. Don’t hesitate to contact me, message me on whatssap. I’m waitting for you We Are Provide Escorts Service All OYO Hotels ,3*,4*,5* Star Hotel And Home Flat, Apartment. Guest-House. Services In -Call And Out – Call Both Are Services Available. 24Hrs. Any Time Any Where Call Whatsapp, +91-◖9833363713 ◗ Our Services and Rates: – – In call Shot 1500 Out Call Short 2000 : – In call Night 6000 Out Call Night 7000 Minimum To Maximum Range Available Only Serious And Genuine Persons Can Contact Us : +91-◖9833363713 ◗ More Information And Contact Profile Real Pic Visit Our Website City Wise Escorts Service Agency. Good Looking Cheap And Best Models Girls U Can Get Best Click On Link

Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...

aartirawatdelhi

☑️░ 9630942363 ░ CALL GIRLS ░ VIP ░ ESCORT ░ SERVICES ░ AGENCY ░ 9630942363 THE GENUINE ESCORT AGENCY VIP LUXURY CALL GIRLS HIGH CLASS MODELS CALL GIRLS GENUINE ESCORT BOOK BOOK APPOINTMENT - 9630942363 THE GENUINE ESCORT AGENCY BEST VIP CALL GIRLS & ESCORTS SERVICE 9630942363 VIP CALL GIRLS ALL TYPE WOMEN AVAILABLE INCALL & OUTCALL BOTH AVAILABLE BOOK NOW 9630942363 VIP GENUINE INDEPENDENT ESCORT AGENCY VIP PRIVATE AUNTIES BEAUTIFUL LOOKING HOT AND SEXT GIRLS AND PARTY TYPE GIRLS YOU WANT SERVICE THEN CALL THIS NUMBER 9630942363 ROOM ALSO PROVIDE HOME & HOTELS SERVICE FULL SAFE AND SECURE WORK WITHOUT CONDOMS, ORAL, SUCKING, LIP TO LIP, ANAL, BACK SHOTS, SEX 69, WITHOUT BLOWJOB AND MUCH MORE FOR BOOKING 9630942363

Call Girls Vasai Virar Just Call 9630942363 Top Class Call Girl Service Avail...

GENUINE ESCORT AGENCY

9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service

GENUINE ESCORT AGENCY

Models Call Girls In Hyderabad 9630942363 Hyderabad Call Girl & Hyderabad Esc...

GENUINE ESCORT AGENCY

Call Girls Kolkata Kalikapur 💯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.

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

Namrata Singh

Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available

GENUINE ESCORT AGENCY

Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 hours available Call Mr Chirag Ji +91-7427069034 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, 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 Chennai 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 Chennai 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 — 7427069034 !! Thank you for Visiting.

Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...

hotbabesbook

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 8250077686 Top Class Call Girl Service Available

Dipal Arora

Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl In 5 Star Hotel Service Available Booking Contact Details WhatsApp Chat: +91-8617370543 Guwahati Escort Service includes providing maximum physical satisfaction to their clients as well as engaging conversation that keeps your time enjoyable and entertaining. Plus they look fabulously elegant; making an impressionable Independent Escorts Guwahati understands the value of confidentiality and discretion - they will go the extra mile to meet your needs. Simply contact them via text messaging or through their online profiles; they'd be more than delighted to accommodate any request or arrange a romantic date or fun-filled night together. We provide - Flexibility Choices and options Lists of many beauty fantasies Turn your dream into reality Perfect companionship Cheap and convenient In-call and Out-call services And many more.

Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...

Dipal Arora

💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lonely Housewife In Top Rated Hotel WhatsApp Chat : +91-9257276172 Get More Information About Jaipur Escorts Service Jaipur 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.

💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...

khalifaescort01

Top Rated Bangalore Call Girls Mg Road ⟟ ⟟ Call Me For Genuine Sex Service At Affordable Rate Booking Contact Details Whatsapp Chat :+91- These professional and Call girls in Bangalore can satisfy your every desire - be it sensual massage or an erotic shower, they are always more than willing to meet them. Furthermore, they pay close attention to body language cues to ensure you enjoy every minute spent in their company - both in-call and outcall services are offered. Is an excellent choice for anyone seeking an exciting and thrilling night of fun and excitement The Oberoi, Bengaluru Taj West End The Leela Palace Bengaluru JW Marriott Hotel Bengaluru The Ritz-Carlton, Bangalore Sheraton Grand Bangalore Hotel at Brigade Gateway Conrad Bengaluru ITC Gardenia, Bengaluru Renaissance Bengaluru Race Course Hotel The Lalit Ashok Bangalore

Most Beautiful Call Girl in Bangalore Contact on Whatsapp

Inaaya Sharma

(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Celebrity for 5* Hotels Booking Details Are here 05-May-2024( Mj) 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! 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 Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...

parulsinha

Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Rishikesh Escorts Call girls are available to provide the quality essentialness that will ease away life's tensions. Rishikesh Escorts are regular companions of elite gentlemen. It is possible to take them to places they would never have dreamed of visiting otherwise. Their portfolios can be found online through escort agencies; they maintain themselves to look attractive by visiting salons and spas regularly. 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 skilled at performing wild anal sex, deep throat sex and cum eating - ideal for satisfying all your sexual needs and playing any game possible. Professional assistants are readily available and ready to assist in any situation - romantic date or solo outing. They can accompany you to restaurants or bars where their presence will surely leave an impression with their beautiful appearances and striking personalities.

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

perfect solution

The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Miss This Chance Of Getting Into My Sexy Boobs?t Booking Contact Details WhatsApp Chat: +91-9332606886 Hyderabad Escort Service includes providing maximum physical satisfaction to their clients as well as engaging conversation that keeps your time enjoyable and entertaining. Plus they look fabulously elegant; making an impressionable Independent Escorts Hyderabad understands the value of confidentiality and discretion - they will go the extra mile to meet your needs. Simply contact them via text messaging or through their online profiles; they'd be more than delighted to accommodate any request or arrange a romantic date or fun-filled night together. We provide - Flexibility Choices and options Lists of many beauty fantasies Turn your dream into reality Perfect companionship Cheap and convenient In-call and Out-call services And many more. 01-May(Ast)

The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...

chandars293

Recently uploaded (20)