Awake Intubation the EMCrit Way

•

8 recomendaciones•4,236 vistas

Scott Weingart revisits his famous video, illustrating how awake intubation can be done efficiently and effectively, with the proper preparation.

Salud y medicina

Apneic
RSI Awake
Crash
Tough
YesNo
Yes
No

Any predicted difficult airway
that isn’t crash

Dry ‘em out
Topicalize
Sedate
Ready the Patient
Intubate

Antisialagogue
(Choose 1)
·
Glycopyrolate 0.2-0.4 mg IV
Atropine 0.5-1 mg IV
·

My resident, Raghu,
was teased for months for
that last suctioning
Sorry, Raghu!

Spray the back of the oropharynx if
necessary

I should have
smurfed the
methylene
blue!

TransTracheal
Injection
(optional)
3cc of 4% Lidocaine

MAD Below Cords
(optional)
3cc of 4% Lidocaine

Ketofol
75% Ketamine and 25% Propofol in a syringe (15/5 cc of
each)

Optimally Position the
Patient
R. Levitan

Equipment check
Fiberoptic Laryngoscope/Stylet
Bougie
8-0 Tube
7-0 Tube
Extra Ketofol
LMA
Cric Set-up
Paralytic
Syringe with MAD with 4%
Suction/BVM/ETCO2

1. Fiberoptic Bronch
2. Fiberoptic Stylet
3. Video Laryngoscope
4. Standard Laryngoscope

Más contenido relacionado

La actualidad más candente

Complete fiberoptic

gaganbrar18

Awake intubation

ZIKRULLAH MALLICK

Raj care laryngospasm ppt

dr rajkumarr titarmare

Tracheo Esophageal Fistula and Anesthesia

Dr.S.N.Bhagirath ..

Management of Bronchospasm during General Anaesthesia

Ashwin Haridas

Inhalational anaesthetic agents

gaganbrar18

Difficult airway

Pratyush1693

Epidural anesthesia & analgesia

SRINIVAS UNDURTY

Induction of anaesthesia

Parul Gupta

Peripheral nerve blocks

Amit Lall

Post tonsillectomy bleed & anesthesia considerations

madhu chaitanya

Thrive

Shreyas Kate

Paediatric breathing systems

Arthi Rajasankar

Low flow Anesthesia system

KIMS

Lma, laryngospasm and pulmonary edema

Mosese HULKSTAH Tuapati JNR

Neonatal and paediatric anaesthesia

Shoaib Kashem

Geriatric anaesthesia

Dr Nandini Deshpande

Anaesthesia For Obese Patient

Shailendra Veerarajapura

AEC

Raju Abraham

post operative cognitive dysfunction

priyanka gupta

La actualidad más candente (20)

Complete fiberoptic

Awake intubation

Raj care laryngospasm ppt

Tracheo Esophageal Fistula and Anesthesia

Management of Bronchospasm during General Anaesthesia

Inhalational anaesthetic agents

Difficult airway

Epidural anesthesia & analgesia

Induction of anaesthesia

Peripheral nerve blocks

Post tonsillectomy bleed & anesthesia considerations

Thrive

Paediatric breathing systems

Low flow Anesthesia system

Lma, laryngospasm and pulmonary edema

Neonatal and paediatric anaesthesia

Geriatric anaesthesia

Anaesthesia For Obese Patient

AEC

post operative cognitive dysfunction

Destacado

Ben Shippey discusses the important anaesthetic considerations in bariatric surgery. Obesity surgery can induce a strong response in healthcare professionals. These biases must be overcome to facilitate efficient and safe services. Evidently, Bariatric surgery provides many challenges. To begin with, healthcare professionals can associate negative thoughts with obesity. Secondly, these patients present complex respiratory and cardiovascular physiology that must be considered. Ben highlights three important considerations when preparing for, and delivery anaesthetics in the bariatric population. These are Attitude, Assessment and Act. Attitude - Encompasses the attitude of the physicians, theatre team and the patient themselves. One must recognise and change their thinking about the obese patient. Ben’s team does this by realising the complex psychological background these patients invariably have. Assessment - Furthermore, a multidisciplinary team must undertake a broad assessment. Specifically for the anaesthetic team, there is a complex decision pathway, especially with managing the airway. The broad principle should be to shorten the time between the awake, vertical, spontaneously breathing obese person and the supine, anaesthetised, intubated and positively pressure ventilated patient. Finally, Act - As Ben states, the previous two points are null and void if it does not change practice. The key element to act is to plan! This involves having a clear action plan for the intubation of the patient and failing that, clear points at which Plan B, C and D will be initiated. He encourages his theatre staff to alert him when a cut off Sp02 is reached so he can move to the next course of action. He comes prepared - for example, by having the cricothyroid membrane marked out. Furthermore, it is important to consider putting the patient to sleep and waking them up. As Ben puts it – pay attention to the take off as well as the landing! Lastly, the post-operative care is significantly important. Remember patient positioning in bed (not slumped) and encourage early mobilisation. These patients need to be up and moving, as well as having the appropriate DVT prophylaxis in place. The obese patient presents unique challenges to the anaesthetist. Anaesthetics in Bariatric Surgery: Ben Shippey For more like this, head to our podcast page. #CodaPodcast

Anaesthetics in Bariatric Surgery: Ben Shippey

SMACC Conference

Scott Weingart discusses the scientific aspects of meditation. He believes meditation is to the mind what exercise is to the body. There are two types of meditation: focussed attention meditation or vipassana, and contemplative meditation. Generally, people exist in a default mode network. This happens when we are not focussed on anything in particular and thoughts occur in our brain without us being aware of it. Spending a few minutes every day aware of what thoughts are occurring in our brain is highly beneficial. This helps with stress control, relaxation response control, slowing of telomere degradation, control over emotions and increased concentration. Scott, however, wants us to focus on a single objective benefit of meditation - controlling the stimulus-response gap. Viktor E. Frankl explains - “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” Meditation helps to choose our responses to stimuli, both good and bad. Scott explains how to do mindfulness meditation or vipassana. First, pay attention to your present circumstance by linking it to your breath. Second, be non-judgemental and forgive yourself for the random thoughts that come up while meditating. Finally, watch moment by moment as experiences unfold. A book written by William B. Irvine on Stoics, introduced Scott to contemplative mediation. Stoicism is based on a philosophy of happiness which tries to eliminate negative emotions like hate, envy, anxiety, and fear. Scott dedicates this podcast to John Hinds by explaining how he appreciated the moments he spent with John due to his practising of mindfulness. Meditation is a way to appreciate every moment that we have in our short life. Exercise is work to live longer, while meditation is work to live better. Finally, for more like this, head to our podcast page. #CodaPodcast

Meditation Performance and Critical Care: Scott Weingart

SMACC Conference

Rich Levitan - Extreme Airways

SMACC Conference

ARDS: An Evidence-based Update. By Mac Sweeney.

SMACC Conference

Beardsell - Pain and Suffering in the ED

SMACC Conference

Ciaran McKenna discusses 3D printing of high fidelity simulation equipment. Simulation training is useful, but it is often a costly exercise. However, according to Ciaran McKenna, it doesn't have to be. Ciaran shares his experience of using 3D printing to create simulation equipment. According to Ciaran, anyone with basic computer skills is capable of making their own 3D solutions for simulation training. For example, he demonstrates how to design and print a basic mackintosh blade using 3D modelling. Training for rare procedures can be very costly using the traditional simulation methods. However, training for such procedures shouldn't be avoided. Therefore, creating low cost, high fidelity SIM equipment is key. Furthermore, Ciaran explains how 3D scanners can be attached to iPads to take accurate facial contours of a person. Ciaran demonstrates how to make a mould of a person’s neck and then 3D print it. This mould is re-usable and cost effective. Ciaran discusses the benefits of 3D printing and how it is an excellent alternative to expensive simulation equipment that is often out of reach for many facilities. Ultimately, 3D printing of high fidelity simulation equipment is a good option. Ciaran is hopeful that more people will reap the benefits of 3D printing in the future.

3D printing of high fidelity simulation equipment

SMACC Conference

Aicu c-10(shock)

Shery Hassan

Upper C-spine Fractures Azam Basheer

Azam Basheer

Head injury

KING SAUD HOSPITAL

Cervical Fractures and Cervical spine injuries - Dr.KK

Queen Mary Hospital

Using Simulation for Change

Jesse Spurr

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

Resuscitation Technology

David Hiltz

1455 wilson 15

SMACC Conference

Hacking medical education 20150604

precordialthump

YOUR Medical Education 2.0

David Marcus

CPR That Saves Lives

Salim Rezaie

Burns Airway Management by Gatward

SMACC Conference

Integrating In Situ Simulation

Jesse Spurr

Stuart Lane on prognostication post out of hospital cardiac arrest

SMACC Conference

Destacado (20)

Anaesthetics in Bariatric Surgery: Ben Shippey

Meditation Performance and Critical Care: Scott Weingart

Rich Levitan - Extreme Airways

ARDS: An Evidence-based Update. By Mac Sweeney.

Beardsell - Pain and Suffering in the ED

3D printing of high fidelity simulation equipment

Aicu c-10(shock)

Upper C-spine Fractures Azam Basheer

Head injury

Cervical Fractures and Cervical spine injuries - Dr.KK

Using Simulation for Change

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

Resuscitation Technology

1455 wilson 15

Hacking medical education 20150604

YOUR Medical Education 2.0

CPR That Saves Lives

Burns Airway Management by Gatward

Integrating In Situ Simulation

Stuart Lane on prognostication post out of hospital cardiac arrest

Similar a Awake Intubation the EMCrit Way

Canine anesthesia- Dr. Najmu Saaqib Reegoo DVM

Najamu Saaqib Reegoo

Public health c are emphasis on first aid

Liris Thomas

Restrain and Immobilization of wildlife

ravikant1977

Oropharyngeal , nasopharyngeal and naso tracheal suctioning

Jessica Saldana

This presentation is designed to cover some of the principles of Basic Life Support & First Aid as of January 2012. This includes things such as; - DRABCD - Care for Bleeding - Care for Shock - First Aid for Sprains & Strains - Care for dislocations and fractures - Poisoning - Burns - Diabetic Emergencies It is not comprehensive, but is designed to refresh those who have had any previous experience in Basic Life Support. In saying that being able to apply some of these skills is useful for anyone. This is the latest version of the presentation.

Basic Life Support & First Aid 2012

Aaron Sparshott

Principles of management in a case of poisoning part 1

Dr Rizwan Zafar Ansari

Basic life support

Ajay Magar

Basic life support

imangalal

Gede Pardianto - Learning phacoemulsification for tremor surgeons

Gede Pardianto

Airway management

Prasanna Venkatesan Chennai

Antianginal drugs

Aasma Poudel

26. Radiance FIRST AID Presentation.pdf

BaleshTandle1

Additional Information Leaflet With Naloxone Kit

Stephen Malloy

Demostration of injection

Sumit Kumar

Direct application (Fundamental Of Nursing)

MO FAISHAL

Sec1.fa9 poisoning

MeldrickSJAB

FIRST AID by dr kamran

Jinnah hospital Lahore Pakistan

Snake bites

PRAGYANSHREE NANDA

Induction of labor& pain reief inlabor for undergraduate

Faculty of Medicine,Zagazig University,EGYPT

Snake

csmall5

Similar a Awake Intubation the EMCrit Way (20)

Canine anesthesia- Dr. Najmu Saaqib Reegoo DVM

Public health c are emphasis on first aid

Restrain and Immobilization of wildlife

Oropharyngeal , nasopharyngeal and naso tracheal suctioning

Basic Life Support & First Aid 2012

Principles of management in a case of poisoning part 1

Basic life support

Gede Pardianto - Learning phacoemulsification for tremor surgeons

Airway management

Antianginal drugs

26. Radiance FIRST AID Presentation.pdf

Additional Information Leaflet With Naloxone Kit

Demostration of injection

Direct application (Fundamental Of Nursing)

Sec1.fa9 poisoning

FIRST AID by dr kamran

Snake bites

Induction of labor& pain reief inlabor for undergraduate

Snake

Más de 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

Más de 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

Último

♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl 100% Genuine Please Contact Me Booking Contact Details WhatsApp Chat: +91-7001035870 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. 29-Apr(Ast)

♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...

astropune

VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts 🔝 9256729539🔝✔️✔️ One shot: ₹2000/in-call, ₹5000/out-call Two shots with one girl: ₹3500 /in-call, ₱6000/out-call Body to body massage with sex: ₱3000/in-call Full night for one person: ₱7000/in-call, ₱10000/out-call Full night for more than 1 person : Contact us at 9256729539. for details Operating 24/7, we serve various locations in Indore. For premium call girl services in Indore 9256729539. Thank you for considering us !

VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts

aditipandeya

Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Nagpur Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Nagpur 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 Nagpur 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 Nagpur Just Call 9907093804 Top Class Call Girl Service Available

Dipal Arora

Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy Bhabi Ready For Sex At Your Doorstep Booking Contact Details Whatsapp Chat :+91-6297143586 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 1-may-24

Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...

vidya singh

Bangalore Call Girls Nelamangala Number 9332606886 Meetin With Bangalore Escorts Booking Contact Details Whatsapp Chat :+91-9332606886 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 27 apr 24 (LK)

Bangalore Call Girls Nelamangala Number 9332606886 Meetin With Bangalore Esc...

narwatsonia7

Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Aurangabad Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Aurangabad 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 Aurangabad 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 Aurangabad Just Call 8250077686 Top Class Call Girl Service Available

Dipal Arora

VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Their Home & Hotels Why you Choose Us- +91-7877925207 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 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 . A300424ST ★ To Enjoy With Hot and Sexy Girls . ★ We Are Providing :- • 3* 5* 7*Hotels Service • Hygienic Full AC Neat and Clean Rooms Avail. • Daily New Escorts Staff Available • Minimum to Maximum Range Available. HOT⇄ 7877925207 Mr Chirag ji Our escort service •BJ (Blowjob) •FK (French kissing) •Kissing with tongue •O-Level (Oral sex) •Long Silky Brown Hair •69 (69 sex) •A-Level (5 start Escort) •Dating

VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...

jageshsingh5554

Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Cuttack Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Cuttack 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 Cuttack 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 Cuttack Just Call 9907093804 Top Class Call Girl Service Available

Dipal Arora

The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Miss This Chance Of Getting Into My Sexy Boobs? Booking Contact Details WhatsApp Chat: +91-6297143586 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 6297143586 𖠋 Will You Mis...

chandars293

Call Girls Haridwar Just Call 8250077686 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Haridwar Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Haridwar 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 Haridwar 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 Haridwar Just Call 8250077686 Top Class Call Girl Service Available

Dipal Arora

Call Girls Kochi Just Call 8250077686 Top Class Call Girl Service Available Call Girls Kochi Just Call 8250077686 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Kochi Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Kochi 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 Kochi 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 Kochi Just Call 8250077686 Top Class Call Girl Service Available

Dipal Arora

Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time Call Mr Chirag Ji +91-6378878445 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 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 03-May-2024 (chd) 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 — 6378878445 !! Thank you for Visiting.

Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time

Call Girls Delhi

Call Girls Bareilly Just Call 8250077686 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Bareilly Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Bareilly 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 Bareilly 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 Bareilly Just Call 8250077686 Top Class Call Girl Service Available

Dipal Arora

💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Available ) Full Fun With Sex Booking Contact Details WhatsApp Chat: +91-7001035870 Escort Service in Kolkata | 369+ call girls book @₹6k-₹18k/full night cash Hi, I am Taniya Sharma. My age is 25 year old , an independent call girl in Kolkata. I love sex and I'm the only girl in your city that can satisfy you completely. I also provide this service at a very low rate.No Advance Payment Genuine Low Price Kolkata Cash Payment Fully Medically Fit & Competent Girl I am. Book Your GF | 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

💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...

Taniya Sharma

Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service Booking Contact Details Whatsapp Chat :+91-7001035870 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 29 apr 24 (LK)

Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service

vidya singh

Call Girls Siliguri Just Call 8250077686 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Siliguri Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Siliguri 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 Siliguri 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 Siliguri Just Call 8250077686 Top Class Call Girl Service Available

Dipal Arora

Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Dehradun Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Dehradun 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 Dehradun 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 Dehradun Just Call 9907093804 Top Class Call Girl Service Available

Dipal Arora

Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Genuine Sex Service At Affordable Rate Booking Contact Details Whatsapp Chat :+91- 9332606886 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 30 apr 24 (LK)

Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...

narwatsonia7

Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl In 5 Star Hotel Service Available Booking Contact Details WhatsApp Chat: +91-8250192130 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. 29-Apr(Ast)

Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...

astropune

Are you looking for some sexual fun and erotic girl in the vibrant city of Lucknow? Look no further than our top-notch call girl services in Lucknow! Whether you prefer in-call or out-call services, we just need to call or WhatsApp us at 8800925952 In-call and Out-call services for Call girls in Lucknow Looking for privacy? Our in-call services provide a discreet and comfortable setting for your rendezvous with our lovely call girls in Lucknow. Best Price with hotel services When looking for the best-priced call girl in Lucknow, our services at Lucknow Call Girl Service stand out with our exceptional BDSM, GFE, Oral Experience, etc. We provide top-notch experiences that cater to your needs and desires, ensuring a memorable encounter every time. Call or WhatsApp us for more details - 8800925952

Lucknow Call girls - 8800925952 - 24x7 service with hotel room

discovermytutordmt