SlideShare une entreprise Scribd logo
1  sur  20
AGITATION IN ICU
By Dr Minh Le Cong
Royal Flying Doctor Service, Queensland
PREVENTION?
HALOPERIDOL PROPHYLAXIS
Kalisvaart, JAGS 2005;53:1658-1666
HALOPERIDOL AND MORTALITY
TRIAL
MICHAEL C READE*, KIM O'SULLIVAN, SAMANTHA
BATES, DONNA GOLDSMITH, WILLIAM RSTJ
AINSLIE AND RINALDO BELLOMO
CRIT CARE 2009
LESS DELIRIUM, MORE BRADYCARDIA
CHECK OUT WWW.EMCRIT.ORG
1
1
WHAT WOULD YOU PREPARE AND HOW WOULD YOU GIVE IT?
1
3
USE A SEDATION SCORE
1
4
16
ON KETAMINE 80MG/HR
1
7
KETAMINE FOR AGITATION ?? ARE YOU NUTS?
GROWING RESEARCH INTO KETAMINE IN
MENTAL HEALTH
 Rapid antidepressant
 Rapid Anti suicidal effect
 Can ameliorate/resolve PTSD
REFERENCES
 http://images.fineartamerica.com/images-medium/mental-agitation-paulo-zerbato.jpg
 http://www.google.com.au/imgres?imgurl=http://wpmedia.blogs.theprovince.com/2012/09/icu2.j
pg&imgrefurl=http://blogs.theprovince.com/2012/09/25/letters-end-of-life-icu-christy-clark-b-c-
conservatives-food-labels-mp-costs-bike-lanes-
police/&h=377&w=640&sz=90&tbnid=szFE3EPfjrA7gM:&tbnh=92&tbnw=156&zoom=1&usg=__
jEPztWVntCwKHKlLG-
enXTcZLr4=&docid=fRKRotkyBM4wTM&sa=X&ei=wcYeUoSpCquaiQeiyYDoBQ&ved=0CGkQ9
QEwEg&dur=204
 http://www.slideshare.net/hospira2010/patients-gone-wild-agitation-and-delirium-in-the-icu
 http://www.goodrx.com/haloperidol/images#imgModal
 http://emcrit.org/podcasts/human-bondage-chemical-takedown/
 http://media.photobucket.com/user/death_to_amerika/media/fight_club.jpg.html?filters[term]=fig
ht%20club&filters[primary]=images&filters[secondary]=videos&sort=1&o=8
 http://www.mmafighting.com/2013/8/28/4669374/ufc-fight-night-27-photos
 http://i2.listal.com/image/1164347/600full-the-strangler-of-blackmoor-castle-poster.jpg
 http://www.matilda.aktivix.org/collectives/ketamine/myths/1-horse-tranquilliser/horse-
tranquilliser.jpg
 http://www.webmd.com/drugs/drug-1596-
droperidol+Inj.aspx?drugid=1596&drugname=droperidol+Inj&pagenumber=2
 http://www.forbes.com/sites/matthewherper/2013/05/23/johnson-johnson-is-reinventing-the-
party-drug-ketamine-to-treat-depression/

Contenu connexe

Similaire à The Agitated Patient: Protecting Yourself and the Patient

Health Benefits of Seeded Produce 3
Health Benefits of Seeded Produce 3Health Benefits of Seeded Produce 3
Health Benefits of Seeded Produce 3Nickolas Lind
 
Hstlhc save - presentation
Hstlhc save - presentationHstlhc save - presentation
Hstlhc save - presentationashok shinde
 
Preventive healthcare ppt final final for jnanadeepa
Preventive healthcare ppt final final for jnanadeepaPreventive healthcare ppt final final for jnanadeepa
Preventive healthcare ppt final final for jnanadeepaShivanadh K
 
Hari Satu 10. Dr Rochis Diabetes Induced Erectile Dysfunction.pdf
Hari Satu 10. Dr Rochis Diabetes Induced Erectile Dysfunction.pdfHari Satu 10. Dr Rochis Diabetes Induced Erectile Dysfunction.pdf
Hari Satu 10. Dr Rochis Diabetes Induced Erectile Dysfunction.pdfPCIgroup
 
4. The Power of Real Nutrition Science - Unvbelievable Benefits Accrued.pptx
4. The Power of Real Nutrition Science - Unvbelievable Benefits Accrued.pptx4. The Power of Real Nutrition Science - Unvbelievable Benefits Accrued.pptx
4. The Power of Real Nutrition Science - Unvbelievable Benefits Accrued.pptxIvor Cummins
 
1. Chronic Disease Avoidance and Personal Longevity - Ultimate Summary.pptx
1. Chronic Disease Avoidance and Personal Longevity - Ultimate Summary.pptx1. Chronic Disease Avoidance and Personal Longevity - Ultimate Summary.pptx
1. Chronic Disease Avoidance and Personal Longevity - Ultimate Summary.pptxIvor Cummins
 
10 24 09,Final,,, Dr. Neskovics Presentation, Improve Your Vip Health
10 24 09,Final,,, Dr. Neskovics Presentation, Improve Your Vip Health10 24 09,Final,,, Dr. Neskovics Presentation, Improve Your Vip Health
10 24 09,Final,,, Dr. Neskovics Presentation, Improve Your Vip HealthS MIKE NESKOVIC
 
The Logical & Scientific facts about Cholesterol
The Logical & Scientific facts about CholesterolThe Logical & Scientific facts about Cholesterol
The Logical & Scientific facts about Cholesterolfathi neana
 
Mental health and hormones
Mental health and hormonesMental health and hormones
Mental health and hormonesLouis Cady, MD
 
Theories of aging, a nti aging
Theories of aging, a nti agingTheories of aging, a nti aging
Theories of aging, a nti aginggueste6261ab
 
Theories of aging, anti aging
Theories of aging, anti agingTheories of aging, anti aging
Theories of aging, anti aginggueste6261ab
 
Canterpene for-lifespan-healthspan-4dec2010
Canterpene for-lifespan-healthspan-4dec2010Canterpene for-lifespan-healthspan-4dec2010
Canterpene for-lifespan-healthspan-4dec2010Morris Johnson
 
Nutrition, Carb Count For Diabetic Folk's from India
Nutrition, Carb Count For Diabetic Folk's from IndiaNutrition, Carb Count For Diabetic Folk's from India
Nutrition, Carb Count For Diabetic Folk's from IndiaSrinivas Dwarakanath
 

Similaire à The Agitated Patient: Protecting Yourself and the Patient (20)

Health Benefits of Seeded Produce 3
Health Benefits of Seeded Produce 3Health Benefits of Seeded Produce 3
Health Benefits of Seeded Produce 3
 
Hstlhc save - presentation
Hstlhc save - presentationHstlhc save - presentation
Hstlhc save - presentation
 
Preventive healthcare ppt final final for jnanadeepa
Preventive healthcare ppt final final for jnanadeepaPreventive healthcare ppt final final for jnanadeepa
Preventive healthcare ppt final final for jnanadeepa
 
Rheeckoo
RheeckooRheeckoo
Rheeckoo
 
Skin health
Skin health Skin health
Skin health
 
Hari Satu 10. Dr Rochis Diabetes Induced Erectile Dysfunction.pdf
Hari Satu 10. Dr Rochis Diabetes Induced Erectile Dysfunction.pdfHari Satu 10. Dr Rochis Diabetes Induced Erectile Dysfunction.pdf
Hari Satu 10. Dr Rochis Diabetes Induced Erectile Dysfunction.pdf
 
4. The Power of Real Nutrition Science - Unvbelievable Benefits Accrued.pptx
4. The Power of Real Nutrition Science - Unvbelievable Benefits Accrued.pptx4. The Power of Real Nutrition Science - Unvbelievable Benefits Accrued.pptx
4. The Power of Real Nutrition Science - Unvbelievable Benefits Accrued.pptx
 
Fitness
FitnessFitness
Fitness
 
1. Chronic Disease Avoidance and Personal Longevity - Ultimate Summary.pptx
1. Chronic Disease Avoidance and Personal Longevity - Ultimate Summary.pptx1. Chronic Disease Avoidance and Personal Longevity - Ultimate Summary.pptx
1. Chronic Disease Avoidance and Personal Longevity - Ultimate Summary.pptx
 
10 24 09,Final,,, Dr. Neskovics Presentation, Improve Your Vip Health
10 24 09,Final,,, Dr. Neskovics Presentation, Improve Your Vip Health10 24 09,Final,,, Dr. Neskovics Presentation, Improve Your Vip Health
10 24 09,Final,,, Dr. Neskovics Presentation, Improve Your Vip Health
 
Health Secrets to Light 200th Candle By Cap. Ashok Shinde
Health Secrets to Light 200th Candle By  Cap. Ashok ShindeHealth Secrets to Light 200th Candle By  Cap. Ashok Shinde
Health Secrets to Light 200th Candle By Cap. Ashok Shinde
 
The Logical & Scientific facts about Cholesterol
The Logical & Scientific facts about CholesterolThe Logical & Scientific facts about Cholesterol
The Logical & Scientific facts about Cholesterol
 
how to Reduce Body Fat
how to Reduce Body Fathow to Reduce Body Fat
how to Reduce Body Fat
 
Mental health and hormones
Mental health and hormonesMental health and hormones
Mental health and hormones
 
Todd Runestad
Todd RunestadTodd Runestad
Todd Runestad
 
Theories of aging, anti aging
Theories of aging, anti agingTheories of aging, anti aging
Theories of aging, anti aging
 
Theories of aging, a nti aging
Theories of aging, a nti agingTheories of aging, a nti aging
Theories of aging, a nti aging
 
Theories of aging, anti aging
Theories of aging, anti agingTheories of aging, anti aging
Theories of aging, anti aging
 
Canterpene for-lifespan-healthspan-4dec2010
Canterpene for-lifespan-healthspan-4dec2010Canterpene for-lifespan-healthspan-4dec2010
Canterpene for-lifespan-healthspan-4dec2010
 
Nutrition, Carb Count For Diabetic Folk's from India
Nutrition, Carb Count For Diabetic Folk's from IndiaNutrition, Carb Count For Diabetic Folk's from India
Nutrition, Carb Count For Diabetic Folk's from India
 

Plus de SMACC Conference

Precision Medicine in Acute Brain Injury
Precision Medicine in Acute Brain InjuryPrecision Medicine in Acute Brain Injury
Precision Medicine in Acute Brain InjurySMACC Conference
 
CSD by Jeffcote Coda 22.pdf
CSD by Jeffcote Coda 22.pdfCSD by Jeffcote Coda 22.pdf
CSD by Jeffcote Coda 22.pdfSMACC Conference
 
Subdural Haemorrhage and MMA embolisation
Subdural Haemorrhage and MMA embolisationSubdural Haemorrhage and MMA embolisation
Subdural Haemorrhage and MMA embolisationSMACC Conference
 
Andy Neill - More neuroanatomy pearls for neurocritical care
Andy Neill - More neuroanatomy pearls for neurocritical careAndy Neill - More neuroanatomy pearls for neurocritical care
Andy Neill - More neuroanatomy pearls for neurocritical careSMACC Conference
 
The BONANZA Trial and PbTO2 Monitoring
The BONANZA Trial and PbTO2 MonitoringThe BONANZA Trial and PbTO2 Monitoring
The BONANZA Trial and PbTO2 MonitoringSMACC Conference
 
Dilating the Dogma of Vasospasm
Dilating the Dogma of VasospasmDilating the Dogma of Vasospasm
Dilating the Dogma of VasospasmSMACC Conference
 
There is no such thing as mild, moderate and severe TBI - by Andrew Udy
There is no such thing as mild, moderate and severe TBI - by Andrew UdyThere is no such thing as mild, moderate and severe TBI - by Andrew Udy
There is no such thing as mild, moderate and severe TBI - by Andrew UdySMACC Conference
 
TBI Debate - Mild, moderate and severe categories work
TBI Debate - Mild, moderate and severe categories workTBI Debate - Mild, moderate and severe categories work
TBI Debate - Mild, moderate and severe categories workSMACC Conference
 
TBI: when to stop and when to give time
TBI: when to stop and when to give timeTBI: when to stop and when to give time
TBI: when to stop and when to give timeSMACC Conference
 
Ketamine in Brain Injury by Toby Jeffcote
Ketamine in Brain Injury by Toby JeffcoteKetamine in Brain Injury by Toby Jeffcote
Ketamine in Brain Injury by Toby JeffcoteSMACC Conference
 
Managing Complications of Chronic SCI by Bonne Lee
Managing Complications of Chronic SCI by Bonne LeeManaging Complications of Chronic SCI by Bonne Lee
Managing Complications of Chronic SCI by Bonne LeeSMACC Conference
 
EEG and Status Eplilepticus by Tania Farrar
EEG and Status Eplilepticus by Tania FarrarEEG and Status Eplilepticus by Tania Farrar
EEG and Status Eplilepticus by Tania FarrarSMACC Conference
 
Browne Neuro symposium.pptx
Browne Neuro symposium.pptxBrowne Neuro symposium.pptx
Browne Neuro symposium.pptxSMACC Conference
 
Paediatric Stroke by Shree Basu
Paediatric Stroke by Shree BasuPaediatric Stroke by Shree Basu
Paediatric Stroke by Shree BasuSMACC Conference
 
Hypertensing Spinal Cord Injury - gold standard or wacky?
Hypertensing Spinal Cord Injury - gold standard or wacky?Hypertensing Spinal Cord Injury - gold standard or wacky?
Hypertensing Spinal Cord Injury - gold standard or wacky?SMACC Conference
 
Optimal Cerebral Perfusion Pressure
Optimal Cerebral Perfusion PressureOptimal Cerebral Perfusion Pressure
Optimal Cerebral Perfusion PressureSMACC Conference
 
The Power of Words - Death and Language.ppt
The Power of Words - Death and Language.pptThe Power of Words - Death and Language.ppt
The Power of Words - Death and Language.pptSMACC Conference
 
Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Sepsis and Antimicrobial Stewardship - Two Sides of the Same CoinSepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Sepsis and Antimicrobial Stewardship - Two Sides of the Same CoinSMACC Conference
 
Brain injury outcomes and predictors
Brain injury outcomes and predictorsBrain injury outcomes and predictors
Brain injury outcomes and predictorsSMACC Conference
 

Plus de SMACC Conference (20)

Precision Medicine in Acute Brain Injury
Precision Medicine in Acute Brain InjuryPrecision Medicine in Acute Brain Injury
Precision Medicine in Acute Brain Injury
 
CSD by Jeffcote Coda 22.pdf
CSD by Jeffcote Coda 22.pdfCSD by Jeffcote Coda 22.pdf
CSD by Jeffcote Coda 22.pdf
 
Subdural Haemorrhage and MMA embolisation
Subdural Haemorrhage and MMA embolisationSubdural Haemorrhage and MMA embolisation
Subdural Haemorrhage and MMA embolisation
 
Andy Neill - More neuroanatomy pearls for neurocritical care
Andy Neill - More neuroanatomy pearls for neurocritical careAndy Neill - More neuroanatomy pearls for neurocritical care
Andy Neill - More neuroanatomy pearls for neurocritical care
 
The BONANZA Trial and PbTO2 Monitoring
The BONANZA Trial and PbTO2 MonitoringThe BONANZA Trial and PbTO2 Monitoring
The BONANZA Trial and PbTO2 Monitoring
 
Dilating the Dogma of Vasospasm
Dilating the Dogma of VasospasmDilating the Dogma of Vasospasm
Dilating the Dogma of Vasospasm
 
EVD Tips and Tricks
EVD Tips and TricksEVD Tips and Tricks
EVD Tips and Tricks
 
There is no such thing as mild, moderate and severe TBI - by Andrew Udy
There is no such thing as mild, moderate and severe TBI - by Andrew UdyThere is no such thing as mild, moderate and severe TBI - by Andrew Udy
There is no such thing as mild, moderate and severe TBI - by Andrew Udy
 
TBI Debate - Mild, moderate and severe categories work
TBI Debate - Mild, moderate and severe categories workTBI Debate - Mild, moderate and severe categories work
TBI Debate - Mild, moderate and severe categories work
 
TBI: when to stop and when to give time
TBI: when to stop and when to give timeTBI: when to stop and when to give time
TBI: when to stop and when to give time
 
Ketamine in Brain Injury by Toby Jeffcote
Ketamine in Brain Injury by Toby JeffcoteKetamine in Brain Injury by Toby Jeffcote
Ketamine in Brain Injury by Toby Jeffcote
 
Managing Complications of Chronic SCI by Bonne Lee
Managing Complications of Chronic SCI by Bonne LeeManaging Complications of Chronic SCI by Bonne Lee
Managing Complications of Chronic SCI by Bonne Lee
 
EEG and Status Eplilepticus by Tania Farrar
EEG and Status Eplilepticus by Tania FarrarEEG and Status Eplilepticus by Tania Farrar
EEG and Status Eplilepticus by Tania Farrar
 
Browne Neuro symposium.pptx
Browne Neuro symposium.pptxBrowne Neuro symposium.pptx
Browne Neuro symposium.pptx
 
Paediatric Stroke by Shree Basu
Paediatric Stroke by Shree BasuPaediatric Stroke by Shree Basu
Paediatric Stroke by Shree Basu
 
Hypertensing Spinal Cord Injury - gold standard or wacky?
Hypertensing Spinal Cord Injury - gold standard or wacky?Hypertensing Spinal Cord Injury - gold standard or wacky?
Hypertensing Spinal Cord Injury - gold standard or wacky?
 
Optimal Cerebral Perfusion Pressure
Optimal Cerebral Perfusion PressureOptimal Cerebral Perfusion Pressure
Optimal Cerebral Perfusion Pressure
 
The Power of Words - Death and Language.ppt
The Power of Words - Death and Language.pptThe Power of Words - Death and Language.ppt
The Power of Words - Death and Language.ppt
 
Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Sepsis and Antimicrobial Stewardship - Two Sides of the Same CoinSepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
 
Brain injury outcomes and predictors
Brain injury outcomes and predictorsBrain injury outcomes and predictors
Brain injury outcomes and predictors
 

Dernier

Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...astropune
 
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Ishani Gupta
 
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Dipal Arora
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...parulsinha
 
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In AhmedabadO898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In AhmedabadGENUINE ESCORT AGENCY
 
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...aartirawatdelhi
 
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...narwatsonia7
 
Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...
Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...
Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...Sheetaleventcompany
 
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Kochi Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kochi Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kochi Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...astropune
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeCall Girls Delhi
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...chandars293
 
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...Taniya Sharma
 
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service AvailableCall Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Dipal Arora
 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...parulsinha
 
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...hotbabesbook
 

Dernier (20)

Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
 
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
 
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
 
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In AhmedabadO898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
 
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available
 
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
 
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
 
Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...
Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...
Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...
 
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Kochi Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kochi Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kochi Just Call 8250077686 Top Class Call Girl Service Available
 
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
 
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
 
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service AvailableCall Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
 
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
 

The Agitated Patient: Protecting Yourself and the Patient