SlideShare a Scribd company logo
Cricoid Pressure
John Hinds
Conflict of interest
Conflict of interest
My nefarious plan
• Get invited to International conference in
sunny climate
• Captive audience
• Sell you this fabulous new product!
Cricolol
Appraising drugs and therapies
• Steroids in Spinal Cord injury
• Activated Protein C
• Starch solutions
• Therapeutic hypothermia in OOHCA
Cricolol: Early development
• Herbal remedy by Seamus O’Monroe in
1774
Cricolol: Early development
• Rebranded by Seamus O’Sellick in 1961
– 26 patients
– Single hospital observational study
– Non-randomised
– Non-standardised
– Dose was guessed
Administration
• Dedicated assistant during RSI
• 10mg before induction
• 30mg during induction
Administration
• Dedicated assistant during RSI
• 10mg before induction
• 30mg during induction
• Exact dose in syringe is unknown
How much is in the ampoule?
105 trained perioperative nurses
• 5% correct dose
• No correlation between knowledge of
correct dose and actual dose given
(Seamus O’Kozial et al, AORN J 2000)
A half century of Evidence
No randomised controlled trials showing
benefit.
B.S.E.’s
• Quite good at making it difficult to pass
nasogastric tubes
• Quite good for nice pictures in healthy
volunteers having MRI scans
• Some nonsense with Dye
• Seems OK in dead bodies
Any problems?
Makes Airway management
more difficult
• Airway compression in 81%
(O’Smith et al, Anaesthesiology. 2003)
• Airway obstruction in 56%
(O’Hartsilver, Anaesthesia, 2000)
Reduces success with the tube
• Worsens laryngeal view in 29%
(O’Levitan et al, Anal Emerg Med 2006)
• Makes intubation process more difficult
(O’Allman KG. J Clin Anesth 1995)
Increases vomiting and
regurgitation
• Lowers oesophageal sphincter tone and
increases regurgitation
O’Garrad et al, Anaesthesia 2004
O’Chassard et al, Can J Anaesth 1996
Narrow therapeutic window
• Dose of 30mg recommended
– No idea what’s in the ampoule
• You might break the airway
(O’ Heath et al, Br J Anaesth 1996)
• Oesophagus might explode if dose
exceeds 44mg
(O’ Ralph, O’ Wareham, Anaesthesia 1991)
Cricolol
• Evidence in well powered clinical trials
– None.
– Some BSE data
• Evidence of side effects includes:
– Airway collapse in most patients
– Complete airway obstruction in half of patients
– Increased difficulty of intubation
– Physical harm
Cricoid Pressure
3 pet hates of mine
“I use Cricoid Pressure…
I can just take it off if the
airway is difficult”
Sellick
• Cricoid on for induction…
… off at laryngoscopy
• Resulted in the highest reported incidence
of gastric regurgitation, ever.
Beware the “Trained assistant”
“Can I PLEASE have Cricoid?!”
“Can I PLEASE have Cricoid?!”
“Well if you tell me what
cupboard it’s in I’ll get it”
“I don’t believe in Cricoid
Pressure…
but I’m afraid to not use it
because of Guidelines”
Difficult Airway Society
Difficult Airway Society
• “Written guidelines should exist in each
department to cover a number of common
or serious airway problems”
• “An individual practitioner can make a
judgement about which
equipment/technique to use, and is quite
entitled to use any”
“I have to follow the Guidelines”
“Befehl ist Befehl”
Godwin’s
Law
“As an online discussion grows longer,
the probability of a comparison involving
Nazis or Hitler approaches 1”
Vote for Cricoid Pressure
Vote for Cricoid Pressure
• An Idiot.
Vote for Cricoid Pressure
• An Idiot.
• A Nazi.
Cricolol !
30mg
Suppository!
“For all the good
it does, you might
as well just stick
it up your Arse”

More Related Content

What's hot

General anesthesia & obstetrics part II
General anesthesia & obstetrics part IIGeneral anesthesia & obstetrics part II
General anesthesia & obstetrics part II
Sandro Zorzi
 
General anesthesia & obstetrics- c-section part I
General anesthesia & obstetrics- c-section part IGeneral anesthesia & obstetrics- c-section part I
General anesthesia & obstetrics- c-section part I
Sandro Zorzi
 
Respiratory Physiotherapy for Cerebral Palsy
Respiratory Physiotherapy for Cerebral PalsyRespiratory Physiotherapy for Cerebral Palsy
Respiratory Physiotherapy for Cerebral Palsy
RachaelHinton
 
Enhanced Recovery After Surgery
Enhanced Recovery After SurgeryEnhanced Recovery After Surgery
Enhanced Recovery After Surgery
Robiul Karim
 
Salon b 14 kasim 13.30 14.45 kaya yorgancu-ing
Salon b 14 kasim 13.30 14.45 kaya yorgancu-ingSalon b 14 kasim 13.30 14.45 kaya yorgancu-ing
Salon b 14 kasim 13.30 14.45 kaya yorgancu-ingtyfngnc
 
Eras cambodia
Eras cambodiaEras cambodia
Eras cambodia
Yves Van Nieuwenhove
 
ERAS! THE ROLE OF ANAESTHESIOLOGIST
ERAS!   THE ROLE OF ANAESTHESIOLOGISTERAS!   THE ROLE OF ANAESTHESIOLOGIST
ERAS! THE ROLE OF ANAESTHESIOLOGIST
Perundurai Vijayakumar
 
ERAS : Role of anaesthesiaologist
ERAS : Role of anaesthesiaologistERAS : Role of anaesthesiaologist
ERAS : Role of anaesthesiaologist
Parul Gupta
 
Neurophysiological facilitation of respiration [npf]
Neurophysiological facilitation of respiration [npf]Neurophysiological facilitation of respiration [npf]
Neurophysiological facilitation of respiration [npf]
Rekha Marbate
 
Enhanced recovery after surgery (eras)
Enhanced recovery after surgery (eras)Enhanced recovery after surgery (eras)
Enhanced recovery after surgery (eras)
Sanjay Dange
 
Eras protocol (3)
Eras protocol (3)Eras protocol (3)
Eras protocol (3)
asik hossain
 
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...
iosrjce
 
Scott Weingart - Emergent Intubation Resequenced
Scott Weingart - Emergent Intubation ResequencedScott Weingart - Emergent Intubation Resequenced
Scott Weingart - Emergent Intubation Resequenced
SMACC Conference
 
Sumary of surviving sepsis campaign 2008
Sumary of surviving sepsis campaign 2008Sumary of surviving sepsis campaign 2008
Sumary of surviving sepsis campaign 2008AR Muhamad Na'im
 
Combined Spinal Epidural Anesthesia
Combined Spinal Epidural AnesthesiaCombined Spinal Epidural Anesthesia
Combined Spinal Epidural AnesthesiaBilal Baig
 
7 3-9 - chest physiotherapy
7 3-9 - chest physiotherapy7 3-9 - chest physiotherapy
7 3-9 - chest physiotherapyChris Ellen Tan
 
Prone positioning new
Prone positioning newProne positioning new
Prone positioning new
Bacolod Adventist Medical Center
 
ERAS Protocol
ERAS ProtocolERAS Protocol
ERAS Protocol
ankit0019
 

What's hot (19)

General anesthesia & obstetrics part II
General anesthesia & obstetrics part IIGeneral anesthesia & obstetrics part II
General anesthesia & obstetrics part II
 
PHRCS0837 Respiratory Care Newsletter_V10_FA
PHRCS0837 Respiratory Care Newsletter_V10_FAPHRCS0837 Respiratory Care Newsletter_V10_FA
PHRCS0837 Respiratory Care Newsletter_V10_FA
 
General anesthesia & obstetrics- c-section part I
General anesthesia & obstetrics- c-section part IGeneral anesthesia & obstetrics- c-section part I
General anesthesia & obstetrics- c-section part I
 
Respiratory Physiotherapy for Cerebral Palsy
Respiratory Physiotherapy for Cerebral PalsyRespiratory Physiotherapy for Cerebral Palsy
Respiratory Physiotherapy for Cerebral Palsy
 
Enhanced Recovery After Surgery
Enhanced Recovery After SurgeryEnhanced Recovery After Surgery
Enhanced Recovery After Surgery
 
Salon b 14 kasim 13.30 14.45 kaya yorgancu-ing
Salon b 14 kasim 13.30 14.45 kaya yorgancu-ingSalon b 14 kasim 13.30 14.45 kaya yorgancu-ing
Salon b 14 kasim 13.30 14.45 kaya yorgancu-ing
 
Eras cambodia
Eras cambodiaEras cambodia
Eras cambodia
 
ERAS! THE ROLE OF ANAESTHESIOLOGIST
ERAS!   THE ROLE OF ANAESTHESIOLOGISTERAS!   THE ROLE OF ANAESTHESIOLOGIST
ERAS! THE ROLE OF ANAESTHESIOLOGIST
 
ERAS : Role of anaesthesiaologist
ERAS : Role of anaesthesiaologistERAS : Role of anaesthesiaologist
ERAS : Role of anaesthesiaologist
 
Neurophysiological facilitation of respiration [npf]
Neurophysiological facilitation of respiration [npf]Neurophysiological facilitation of respiration [npf]
Neurophysiological facilitation of respiration [npf]
 
Enhanced recovery after surgery (eras)
Enhanced recovery after surgery (eras)Enhanced recovery after surgery (eras)
Enhanced recovery after surgery (eras)
 
Eras protocol (3)
Eras protocol (3)Eras protocol (3)
Eras protocol (3)
 
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...
 
Scott Weingart - Emergent Intubation Resequenced
Scott Weingart - Emergent Intubation ResequencedScott Weingart - Emergent Intubation Resequenced
Scott Weingart - Emergent Intubation Resequenced
 
Sumary of surviving sepsis campaign 2008
Sumary of surviving sepsis campaign 2008Sumary of surviving sepsis campaign 2008
Sumary of surviving sepsis campaign 2008
 
Combined Spinal Epidural Anesthesia
Combined Spinal Epidural AnesthesiaCombined Spinal Epidural Anesthesia
Combined Spinal Epidural Anesthesia
 
7 3-9 - chest physiotherapy
7 3-9 - chest physiotherapy7 3-9 - chest physiotherapy
7 3-9 - chest physiotherapy
 
Prone positioning new
Prone positioning newProne positioning new
Prone positioning new
 
ERAS Protocol
ERAS ProtocolERAS Protocol
ERAS Protocol
 

Similar to Cricolol by John Hinds at smaccGOLD

General anesthesia
General anesthesia General anesthesia
General anesthesia
Alvi Fatima
 
Labor analgesia
Labor analgesiaLabor analgesia
Labor analgesia
Muhammad Muneeb Riaz
 
Anwser,s 9
Anwser,s 9Anwser,s 9
Anwser,s 9
ANAS ALSOHLE
 
Headaches and migraines
Headaches and migrainesHeadaches and migraines
Headaches and migraines
John Bergman
 
Headaches and migraines
Headaches and migrainesHeadaches and migraines
Headaches and migraines
John Bergman
 
Anesthesia. General anesthesia. Anesthetis.ppt
Anesthesia. General anesthesia. Anesthetis.pptAnesthesia. General anesthesia. Anesthetis.ppt
Anesthesia. General anesthesia. Anesthetis.ppt
killerbekzat
 
Pharmacological behavior management
Pharmacological behavior managementPharmacological behavior management
Pharmacological behavior management
asjad ansari
 
Uterine Rupture OSCE
Uterine Rupture OSCEUterine Rupture OSCE
Uterine Rupture OSCE
nicoletanww
 
Answer.s
Answer.sAnswer.s
Answer.s
ANAS ALSOHLE
 
Nitrous Oxide for Labor Analgesia
Nitrous Oxide for Labor AnalgesiaNitrous Oxide for Labor Analgesia
Nitrous Oxide for Labor Analgesia
Allina Health
 
Updates on Asthma and COPD
Updates on Asthma and COPD Updates on Asthma and COPD
Updates on Asthma and COPD
Chew Keng Sheng
 
adrenal gland part 1.pptx
adrenal gland part 1.pptxadrenal gland part 1.pptx
adrenal gland part 1.pptx
KhaledAlsharafy2
 
Paradigms, Dogmas and Evidence in Critical Care - Bellomo
Paradigms, Dogmas and Evidence in Critical Care - BellomoParadigms, Dogmas and Evidence in Critical Care - Bellomo
Paradigms, Dogmas and Evidence in Critical Care - Bellomo
intensivecaresociety
 
How to prepare a patient for laparoscopy ?
How to prepare a patient for laparoscopy ?How to prepare a patient for laparoscopy ?
How to prepare a patient for laparoscopy ?
Mahmoud Abdel-Aleem
 
Chronic cough4 09
Chronic cough4 09Chronic cough4 09
Chronic cough4 09donbukstein
 
Anwser,s 12
Anwser,s 12Anwser,s 12
Anwser,s 12
ANAS ALSOHLE
 
General anesthesia
General anesthesiaGeneral anesthesia
General anesthesia
KathirvelGopalakrish
 
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09 (2).ppt
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09 (2).pptAerodigestive_Foreign_Bodies_AMendelsohn_3-25-09 (2).ppt
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09 (2).ppt
Ravi Ravi
 
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09_0.ppt
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09_0.pptAerodigestive_Foreign_Bodies_AMendelsohn_3-25-09_0.ppt
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09_0.ppt
ssuserf871e8
 
opc posioning final.pptx
opc posioning final.pptxopc posioning final.pptx
opc posioning final.pptx
mdtaieb1
 

Similar to Cricolol by John Hinds at smaccGOLD (20)

General anesthesia
General anesthesia General anesthesia
General anesthesia
 
Labor analgesia
Labor analgesiaLabor analgesia
Labor analgesia
 
Anwser,s 9
Anwser,s 9Anwser,s 9
Anwser,s 9
 
Headaches and migraines
Headaches and migrainesHeadaches and migraines
Headaches and migraines
 
Headaches and migraines
Headaches and migrainesHeadaches and migraines
Headaches and migraines
 
Anesthesia. General anesthesia. Anesthetis.ppt
Anesthesia. General anesthesia. Anesthetis.pptAnesthesia. General anesthesia. Anesthetis.ppt
Anesthesia. General anesthesia. Anesthetis.ppt
 
Pharmacological behavior management
Pharmacological behavior managementPharmacological behavior management
Pharmacological behavior management
 
Uterine Rupture OSCE
Uterine Rupture OSCEUterine Rupture OSCE
Uterine Rupture OSCE
 
Answer.s
Answer.sAnswer.s
Answer.s
 
Nitrous Oxide for Labor Analgesia
Nitrous Oxide for Labor AnalgesiaNitrous Oxide for Labor Analgesia
Nitrous Oxide for Labor Analgesia
 
Updates on Asthma and COPD
Updates on Asthma and COPD Updates on Asthma and COPD
Updates on Asthma and COPD
 
adrenal gland part 1.pptx
adrenal gland part 1.pptxadrenal gland part 1.pptx
adrenal gland part 1.pptx
 
Paradigms, Dogmas and Evidence in Critical Care - Bellomo
Paradigms, Dogmas and Evidence in Critical Care - BellomoParadigms, Dogmas and Evidence in Critical Care - Bellomo
Paradigms, Dogmas and Evidence in Critical Care - Bellomo
 
How to prepare a patient for laparoscopy ?
How to prepare a patient for laparoscopy ?How to prepare a patient for laparoscopy ?
How to prepare a patient for laparoscopy ?
 
Chronic cough4 09
Chronic cough4 09Chronic cough4 09
Chronic cough4 09
 
Anwser,s 12
Anwser,s 12Anwser,s 12
Anwser,s 12
 
General anesthesia
General anesthesiaGeneral anesthesia
General anesthesia
 
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09 (2).ppt
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09 (2).pptAerodigestive_Foreign_Bodies_AMendelsohn_3-25-09 (2).ppt
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09 (2).ppt
 
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09_0.ppt
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09_0.pptAerodigestive_Foreign_Bodies_AMendelsohn_3-25-09_0.ppt
Aerodigestive_Foreign_Bodies_AMendelsohn_3-25-09_0.ppt
 
opc posioning final.pptx
opc posioning final.pptxopc posioning final.pptx
opc posioning final.pptx
 

More from precordialthump

Ten tips for the resuscitationist 2019
Ten tips for the resuscitationist 2019Ten tips for the resuscitationist 2019
Ten tips for the resuscitationist 2019
precordialthump
 
Antidotes: Resus Essentials 2019
Antidotes: Resus Essentials 2019Antidotes: Resus Essentials 2019
Antidotes: Resus Essentials 2019
precordialthump
 
Lung Transplantation by David Pilcher
Lung Transplantation by David PilcherLung Transplantation by David Pilcher
Lung Transplantation by David Pilcher
precordialthump
 
Severe Burns by Andrew Udy
Severe Burns by Andrew UdySevere Burns by Andrew Udy
Severe Burns by Andrew Udy
precordialthump
 
Nickson training for stress 20170720
Nickson training for stress 20170720Nickson training for stress 20170720
Nickson training for stress 20170720
precordialthump
 
Mechanical ventilation pitfalls in asthma management
Mechanical ventilation pitfalls in asthma managementMechanical ventilation pitfalls in asthma management
Mechanical ventilation pitfalls in asthma management
precordialthump
 
ECPR by Vincent Pellegrino 2016
ECPR by Vincent Pellegrino 2016ECPR by Vincent Pellegrino 2016
ECPR by Vincent Pellegrino 2016
precordialthump
 
Shock... Now What?
Shock... Now What?Shock... Now What?
Shock... Now What?
precordialthump
 
Ecg in Toxicology
Ecg in ToxicologyEcg in Toxicology
Ecg in Toxicology
precordialthump
 
Toxicology: What NOT to do
Toxicology: What NOT to doToxicology: What NOT to do
Toxicology: What NOT to do
precordialthump
 
Paracetamol toxicity
Paracetamol toxicityParacetamol toxicity
Paracetamol toxicity
precordialthump
 
Antidotes in the Emergency Department
Antidotes in the Emergency DepartmentAntidotes in the Emergency Department
Antidotes in the Emergency Department
precordialthump
 
An Approach to the acutely poisoned patient
An Approach to the acutely poisoned patientAn Approach to the acutely poisoned patient
An Approach to the acutely poisoned patient
precordialthump
 
Why Don't We Wash Our Hands?
Why Don't We Wash Our Hands?Why Don't We Wash Our Hands?
Why Don't We Wash Our Hands?
precordialthump
 
The future of medical education
The future of medical educationThe future of medical education
The future of medical education
precordialthump
 
No apologies: intubation of the shocked patient
No apologies: intubation of the shocked patientNo apologies: intubation of the shocked patient
No apologies: intubation of the shocked patient
precordialthump
 
Hacking medical education 20150604
Hacking medical education 20150604Hacking medical education 20150604
Hacking medical education 20150604
precordialthump
 
Euboxia and abnormality smacc gold
Euboxia and abnormality smacc goldEuboxia and abnormality smacc gold
Euboxia and abnormality smacc gold
precordialthump
 
FOAM for University of Melbourne MD Student Conference 2014
FOAM for University of Melbourne MD Student Conference 2014FOAM for University of Melbourne MD Student Conference 2014
FOAM for University of Melbourne MD Student Conference 2014
precordialthump
 

More from precordialthump (20)

Ten tips for the resuscitationist 2019
Ten tips for the resuscitationist 2019Ten tips for the resuscitationist 2019
Ten tips for the resuscitationist 2019
 
Antidotes: Resus Essentials 2019
Antidotes: Resus Essentials 2019Antidotes: Resus Essentials 2019
Antidotes: Resus Essentials 2019
 
Lung Transplantation by David Pilcher
Lung Transplantation by David PilcherLung Transplantation by David Pilcher
Lung Transplantation by David Pilcher
 
Severe Burns by Andrew Udy
Severe Burns by Andrew UdySevere Burns by Andrew Udy
Severe Burns by Andrew Udy
 
Nickson training for stress 20170720
Nickson training for stress 20170720Nickson training for stress 20170720
Nickson training for stress 20170720
 
Mechanical ventilation pitfalls in asthma management
Mechanical ventilation pitfalls in asthma managementMechanical ventilation pitfalls in asthma management
Mechanical ventilation pitfalls in asthma management
 
ECPR by Vincent Pellegrino 2016
ECPR by Vincent Pellegrino 2016ECPR by Vincent Pellegrino 2016
ECPR by Vincent Pellegrino 2016
 
Shock... Now What?
Shock... Now What?Shock... Now What?
Shock... Now What?
 
Ecg in Toxicology
Ecg in ToxicologyEcg in Toxicology
Ecg in Toxicology
 
Toxicology: What NOT to do
Toxicology: What NOT to doToxicology: What NOT to do
Toxicology: What NOT to do
 
Paracetamol toxicity
Paracetamol toxicityParacetamol toxicity
Paracetamol toxicity
 
Antidotes in the Emergency Department
Antidotes in the Emergency DepartmentAntidotes in the Emergency Department
Antidotes in the Emergency Department
 
An Approach to the acutely poisoned patient
An Approach to the acutely poisoned patientAn Approach to the acutely poisoned patient
An Approach to the acutely poisoned patient
 
Why Don't We Wash Our Hands?
Why Don't We Wash Our Hands?Why Don't We Wash Our Hands?
Why Don't We Wash Our Hands?
 
The future of medical education
The future of medical educationThe future of medical education
The future of medical education
 
No apologies: intubation of the shocked patient
No apologies: intubation of the shocked patientNo apologies: intubation of the shocked patient
No apologies: intubation of the shocked patient
 
Hacking medical education 20150604
Hacking medical education 20150604Hacking medical education 20150604
Hacking medical education 20150604
 
Euboxia and abnormality smacc gold
Euboxia and abnormality smacc goldEuboxia and abnormality smacc gold
Euboxia and abnormality smacc gold
 
We all need to speak up
We all need to speak upWe all need to speak up
We all need to speak up
 
FOAM for University of Melbourne MD Student Conference 2014
FOAM for University of Melbourne MD Student Conference 2014FOAM for University of Melbourne MD Student Conference 2014
FOAM for University of Melbourne MD Student Conference 2014
 

Recently uploaded

ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
Swetaba Besh
 
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
bkling
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
sisternakatoto
 
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
GL Anaacs
 
Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
MedicoseAcademics
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
Dr. Vinay Pareek
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
Levi Shapiro
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
VarunMahajani
 
Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...
Sujoy Dasgupta
 
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury  ppt  Upendra pal  optometrist upums saifai etawahOcular injury  ppt  Upendra pal  optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawah
pal078100
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
NephroTube - Dr.Gawad
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
touseefaziz1
 
Knee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdfKnee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdf
vimalpl1234
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
KafrELShiekh University
 
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model SafeSurat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Savita Shen $i11
 
BRACHYTHERAPY OVERVIEW AND APPLICATORS
BRACHYTHERAPY OVERVIEW  AND  APPLICATORSBRACHYTHERAPY OVERVIEW  AND  APPLICATORS
BRACHYTHERAPY OVERVIEW AND APPLICATORS
Krishan Murari
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
aljamhori teaching hospital
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
Little Cross Family Clinic
 
Physiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdfPhysiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdf
MedicoseAcademics
 

Recently uploaded (20)

ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
 
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
 
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
 
Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
 
Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...
 
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury  ppt  Upendra pal  optometrist upums saifai etawahOcular injury  ppt  Upendra pal  optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawah
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
 
Knee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdfKnee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdf
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
 
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model SafeSurat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
 
BRACHYTHERAPY OVERVIEW AND APPLICATORS
BRACHYTHERAPY OVERVIEW  AND  APPLICATORSBRACHYTHERAPY OVERVIEW  AND  APPLICATORS
BRACHYTHERAPY OVERVIEW AND APPLICATORS
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
 
Physiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdfPhysiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdf
 

Cricolol by John Hinds at smaccGOLD