Filters in Intraoperative Neurophysiological Monitoring

•Télécharger en tant que PPTX, PDF•

1 j'aime•484 vues

A

Anurag Tewari MD

Intraoperative neurophysiological monitoring (IONM) is the use of electrophysiological methods such as electroencephalography (EEG), electromyography (EMG), and evoked potentials to monitor the functional integrity of certain neural structures during surgery. The purpose this lecture is to Introduce you to the use of FILTERS in neurophysiological signals in intra operative neurophysiological signals. The AIM of IONM is to reduce the risk to the patient of iatrogenic damage to the nervous system, and/or to provide functional guidance to the surgeon and anesthesiologist.

Santé & Médecine

Anurag Tewari MD
Medsurant Health Academy
B: Filters

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

Anurag Tewari MD
Medsurant Health Academy

AnuragTewariMD
Anurag Tewari MD
Resources
Anurag Tewari MD
30
What is an operational amplifier?
Inverting op-amp circuit
Non-inverting op-amp circuit

Contenu connexe

Tendances

Intraoperative neurophysiological monitoring (IONM) is the use of electrophysiological methods such as electroencephalography (EEG), electromyography (EMG), and evoked potentials to monitor the functional integrity of certain neural structures during surgery. The purpose this lecture is to Introduce you to the neurophysiological signals in intra operative neurophysiological signals. The AIM of IONM is to reduce the risk to the patient of iatrogenic damage to the nervous system, and/or to provide functional guidance to the surgeon and anesthesiologist.

Neurophysiological signals in IONM part IV

Neurophysiological signals in IONM part IV

Neurophysiological signals in IONM part IV

Anurag Tewari MD

Upper Extremity Somatosensory Evoked Potential (Upper SSEP)

Upper Extremity Somatosensory Evoked Potential (Upper SSEP)

Upper Extremity Somatosensory Evoked Potential (Upper SSEP)

Anurag Tewari MD

IONM for Lumbosacral Surgery

IONM for Lumbosacral Surgery

IONM for Lumbosacral Surgery

Anurag Tewari MD

Vagal Nerve Stimulation for epilepsy

Vagal Nerve Stimulation for epilepsy

Vagal Nerve Stimulation for epilepsy

Srirama Anjaneyulu

6 電流、電壓及電阻的測量

阿Samn的物理課本

Leyenda del astrólogo árabe

Leyenda del astrólogo árabe

Leyenda del astrólogo árabe

ELECTROCORTICOGRAPHY(ECOG)

ELECTROCORTICOGRAPHY(ECOG)

ELECTROCORTICOGRAPHY(ECOG)

Dr. ASHUTOSH RATH

Anesthesia and IONM

Anesthesia and IONM

Anesthesia and IONM

Anurag Tewari MD

聴力測定技術講習会 ABRとASSR

聴力測定技術講習会 ABRとASSR

聴力測定技術講習会 ABRとASSR

TeruKamogashira

EDX: Evoked potentilas

EDX: Evoked potentilas

EDX: Evoked potentilas

Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation

Evoked potentials and their clinical application

Evoked potentials and their clinical application

Evoked potentials and their clinical application

Ssep pathways

Shehzad Hussain Raja

Responsive Neurostimulation (RNS) for Intractable Epilepsy

Responsive Neurostimulation (RNS) for Intractable Epilepsy

Responsive Neurostimulation (RNS) for Intractable Epilepsy

Intraoperative Neurophysiological Monitoring Brain

Intraoperative Neurophysiological Monitoring Brain

Intraoperative Neurophysiological Monitoring Brain

Bases neurofisiológicas del eeg parte 1

Bases neurofisiológicas del eeg parte 1

Bases neurofisiológicas del eeg parte 1

Eeg maturation

AliMohammedMohammed

Overview on Motor evoked potential

Overview on Motor evoked potential

Overview on Motor evoked potential

Syed Ahmed Uddin (BSc, REEGT, CNIM)

EEG in convulsive and non convulsive seizures in the intensive care unit

EEG in convulsive and non convulsive seizures in the intensive care unit

EEG in convulsive and non convulsive seizures in the intensive care unit

Pramod Krishnan

Electromyography (EMG) Basics

Electromyography (EMG) Basics

Electromyography (EMG) Basics

MUHAMMED AJMAL P

Tendances (20)

Neurophysiological signals in IONM part IV

Neurophysiological signals in IONM part IV

Neurophysiological signals in IONM part IV

Upper Extremity Somatosensory Evoked Potential (Upper SSEP)

Upper Extremity Somatosensory Evoked Potential (Upper SSEP)

Upper Extremity Somatosensory Evoked Potential (Upper SSEP)

IONM for Lumbosacral Surgery

IONM for Lumbosacral Surgery

IONM for Lumbosacral Surgery

Vagal Nerve Stimulation for epilepsy

Vagal Nerve Stimulation for epilepsy

Vagal Nerve Stimulation for epilepsy

6 電流、電壓及電阻的測量

Leyenda del astrólogo árabe

Leyenda del astrólogo árabe

Leyenda del astrólogo árabe

ELECTROCORTICOGRAPHY(ECOG)

ELECTROCORTICOGRAPHY(ECOG)

ELECTROCORTICOGRAPHY(ECOG)

Anesthesia and IONM

Anesthesia and IONM

Anesthesia and IONM

聴力測定技術講習会 ABRとASSR

聴力測定技術講習会 ABRとASSR

聴力測定技術講習会 ABRとASSR

EDX: Evoked potentilas

EDX: Evoked potentilas

EDX: Evoked potentilas

Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation

Evoked potentials and their clinical application

Evoked potentials and their clinical application

Evoked potentials and their clinical application

Ssep pathways

Responsive Neurostimulation (RNS) for Intractable Epilepsy

Responsive Neurostimulation (RNS) for Intractable Epilepsy

Responsive Neurostimulation (RNS) for Intractable Epilepsy

Intraoperative Neurophysiological Monitoring Brain

Intraoperative Neurophysiological Monitoring Brain

Intraoperative Neurophysiological Monitoring Brain

Bases neurofisiológicas del eeg parte 1

Bases neurofisiológicas del eeg parte 1

Bases neurofisiológicas del eeg parte 1

Eeg maturation

Overview on Motor evoked potential

Overview on Motor evoked potential

Overview on Motor evoked potential

EEG in convulsive and non convulsive seizures in the intensive care unit

EEG in convulsive and non convulsive seizures in the intensive care unit

EEG in convulsive and non convulsive seizures in the intensive care unit

Electromyography (EMG) Basics

Electromyography (EMG) Basics

Electromyography (EMG) Basics

Plus de Anurag Tewari MD

Anesthesiologists play a central role in optimizing IONM. Intraoperative neuromonitoring (IONM) offers a near-real-time assessment of the functional integrity of the neuronal pathways during surgery. Evoked Potential signals may thus be regarded as surrogate markers of neuronal function and can be thought of as a repeated but limited neurological examination under general anesthesia. Optimization of anesthetic management contributes to the successful integration of IONM into perioperative care

Anesthesiology And Intraoperative Neurophysiological Monitoring

Anesthesiology And Intraoperative Neurophysiological Monitoring

Anesthesiology And Intraoperative Neurophysiological Monitoring

Anurag Tewari MD

High-intensity LEDs are embedded in the flash stimulation pad The small disc shape and silicone properties of the pad make it both flexible and lightweight Illuminance can be set up to 20,000 lux, and different light emission times and cycles can be chosen. A common system for placing electrodes is the “10-20 International System” which is based on measurements of head size (Jasper, 1958). The mid-occipital electrode location (OZ) is on the midline. The distance above the inion calculated as 10 % of the distance between the inion and nasion, which is 3-4 cm in most adults Lateral occipital electrodes are a similar distance off the midline. To have reliable VEPs, Intraoperatively, the following factors are important Maintaining normal intraoperative physiological/hemodynamic parameters Use of TIVA instead of inhalational anesthesia Better stimulus delivery methods Recording intraoperative ERG to ensure good retinal stimulation and Employing optimal recording parameters

Intraoperative Flash Visual Evoked Potentials

Intraoperative Flash Visual Evoked Potentials

Intraoperative Flash Visual Evoked Potentials

Anurag Tewari MD

Successful airway management of an infant or child with macroglossia prerequisites recognition of a potential airway problem. We describe our experience with a debilitated 13-year-old girl who presented with severe macroglossia, secondary to lymphangioma of the tongue. Along with the social discomfort she had inability to speak, eat or drink properly and exposure-induced dryness. Such patients are a challenge for the anaesthesiologists due to the anticipated difficult intubation associated with the oral mucosa occupying lesion. It also becomes pertinent to rule out any of the associated congenital anomalies. The importance of a thorough preoperative evaluation and attention to difficult intubation and maintenance of airway is emphasized. We endeavor to review the available literature regarding patient's perioperative management of such patients. Keywords: Airway management, Anesthesia, Lymphangioma, Macroglossia, Difficult airway,

ANAESTHETIC CONSIDERATION IN MACROGLOSSIA DUE TO LYMPHANGIOMA OF TONGUE

ANAESTHETIC CONSIDERATION IN MACROGLOSSIA DUE TO LYMPHANGIOMA OF TONGUE

ANAESTHETIC CONSIDERATION IN MACROGLOSSIA DUE TO LYMPHANGIOMA OF TONGUE

Anurag Tewari MD

The refractory seizures have significant impact on the quality of life and increase long term neurologic and non-neurologic complications. Implantation of Stereotactic Electroencephalography (SEEG) leads is one of the newer surgical techniques intended to localize seizure foci with higher accuracy than the conventional methods. Most of the commonly utilized anesthetic agents depress EEG waveforms affecting intra operative monitoring during these surgeries. Hence, the anesthetic goals include a stable induction and maintenance with agents which have minimal effect on EEG. This article discusses the peri-operative considerations of multiple anti-epileptic medications, recent advances in anesthetic management, and important post-operative concerns. Keywords: Anesthesia, epilepsy surgery, intra-operative EEG, intra operative monitoring, refractory seizures, SEEG, seizure foci, stereotactic electroencephalography

ANESTHETIC CONSIDERATIONS FOR STEREOTACTIC ELECTROENCEPHALOGRAPHY (SEEG) IMP...

ANESTHETIC CONSIDERATIONS FOR STEREOTACTIC ELECTROENCEPHALOGRAPHY (SEEG) IMP...

ANESTHETIC CONSIDERATIONS FOR STEREOTACTIC ELECTROENCEPHALOGRAPHY (SEEG) IMP...

Anurag Tewari MD

CNIM Questions related to Mathematics and Formulas

CNIM Questions related to Mathematics and Formulas

CNIM Questions related to Mathematics and Formulas

Anurag Tewari MD

Intraoperative neurophysiological monitoring team's communiqué with anesthesia professionals. Background and Aims: Intraoperative neurophysiological monitoring (IONM) is the standard of care during many spinal, vascular, and intracranial surgeries. High-quality perioperative care requires the communication and cooperation of several multidisciplinary teams. One of these multidisciplinary services is intraoperative neuromonitoring (IONM), while other teams represent anesthesia and surgery. Few studies have investigated the IONM team's objective communication with anesthesia providers. We conducted a retrospective review of IONM-related quality assurance data to identify how changes in the evoked potentials observed during the surgery were communicated within our IONM-anesthesia team and determined the resulting qualitative outcomes. Material and Methods: Quality assurance records of 3,112 patients who underwent surgical procedures with IONM (from 2010 to 2015) were reviewed. We examined communications regarding perioperative evoked potential or electroencephalography (EEG) fluctuations that prompted neurophysiologists to alert/notify the anesthesia team to consider alteration of anesthetic depth/drug regimen or patient positioning and analyzed the outcomes of these interventions. Results: Of the total of 1280 (41.13%) communications issued, there were 347 notifications and 11 alerts made by the neurophysiologist to the anesthesia team for various types of neuro/orthopedic surgeries. Prompt communication led to resolution of 90% of alerts and 80% of notifications after corrective measures were executed by the anesthesiologists. Notifications mainly related to limb malpositioning and extravasation of intravenous fluid. Conclusion: Based on our institutions' protocol and algorithm for intervention during IONM-supported surgeries, our findings of resolution in alerts and notifications indicate that successful communications between the two teams could potentially lead to improved anesthetic care and patient safety.

Does IONM Help the Anesthesiologists?

Does IONM Help the Anesthesiologists?

Does IONM Help the Anesthesiologists?

Anurag Tewari MD

Every anesthesiologist worth their salt is guilty of administering a wrong drug at least once in their career. Most of the time the consequences have been harmless (albeit not without feeling of guilt or remorse), but in some cases they have caused an undesired iatrogenic morbidity and/or mortality. The high duress milieu of an operation theater (OT), intensive care unit (ICU) or emergency room (ER) predisposes flawed actions. Pediatric population in OT, ICU, or ER is at considerable hazard for medication blunders. Once injected into the blood stream, a drug cannot be retrieved, only countered. A time for change in the field of anesthesiology is inevitable. As indicated previously, medical errors are prevalent within this field and current safety protocol has not been changed in over 60 years. Not only will the implementation of a device like VEINROM increase practitioner's accountability, update patient records in real time and improve the overall health care system, it will most importantly save lives. It is an obligation for standards committee members and medical device manufacturers to implement safeguards that prevent human error. The Institute of medicine estimates that at least 1.5 million Americans are injured each year as a result of EDA, costing the US healthcare field more than 3.5 billion USD annually. The global health care system is in the process of implementing improved standards and regulations that require syringes to be pre-filled by outside pharmacies rather than medical practitioners during the pre-operation period. To support this claim, Transparency Market Research estimates that the global pre-filled syringe market will grow by a 13.3% compound annual rate, reaching a market value of 4.98 billion USD by the year 2019 . These trends point to an estimated 3 billion USD in profit opportunity within the next 7 years. It is our moral and Hippocratic duty to continue risk management processes that decrease the probability of iatrogenic morbidities. For a device such as VEINROM, the time is right and future, bright. Medical device innovation is continuous and safety measures are continually updated. VEINROM is the next step in making the art of anesthesia safer for all involved.

A novel solution for drug error

A novel solution for drug error

A novel solution for drug error

Anurag Tewari MD

Basic Anatomy for Trans-cranial Motor Evoked Potentials Monitoring

Basic Anatomy for Trans-cranial Motor Evoked Potentials Monitoring

Basic Anatomy for Trans-cranial Motor Evoked Potentials Monitoring

Anurag Tewari MD

In extracranial surgeries, as in carotid endarterectomies (CEAs), EEG may be employed to monitor cortex directly at risk for ischemia.When looking for evidence of significant cerebral hypoperfusion, as during carotid endarterectomy, typical criteria indicating the need for carotid shunting are 50% loss of overall amplitude, 50% loss of alpha and beta activity, or a doubling of low-frequency activity

IONM for Carotid Surgery & Carotidendartectomy

IONM for Carotid Surgery & Carotidendartectomy

IONM for Carotid Surgery & Carotidendartectomy

Anurag Tewari MD

IONM for Cerebellopontine Angle Tumor Surgery

IONM for Cerebellopontine Angle Tumor Surgery

IONM for Cerebellopontine Angle Tumor Surgery

Anurag Tewari MD

Guideline 11B: RECOMMENDED STANDARDS FOR INTRAOPERATIVE MONITORING OF SOMATOS...

Guideline 11B: RECOMMENDED STANDARDS FOR INTRAOPERATIVE MONITORING OF SOMATOS...

Guideline 11B: RECOMMENDED STANDARDS FOR INTRAOPERATIVE MONITORING OF SOMATOS...

Anurag Tewari MD

Intraoperative electromyography (EMG) provides useful diagnostic and prognostic information during spine and peripheral nerve surgeries. The basic techniques include free-running EMG, stimulus-triggered EMG, and intraoperative nerve conduction studies. These techniques can be used to monitor nerve roots during spine surgeries, the facial nerve during cerebellopontine angle surgeries, and peripheral nerves during brachial plexus exploration and repair.

Intraoperative Electromyography (EMG)

Intraoperative Electromyography (EMG)

Intraoperative Electromyography (EMG)

Anurag Tewari MD

Electronics and Intra Operative Neurophysiological Monitoring

Electronics and Intra Operative Neurophysiological Monitoring

Electronics and Intra Operative Neurophysiological Monitoring

Anurag Tewari MD

Brainstem Auditory Evoked Potentials Part II

Brainstem Auditory Evoked Potentials Part II

Brainstem Auditory Evoked Potentials Part II

Anurag Tewari MD

Brainstem Auditory Evoked Potentials

Brainstem Auditory Evoked Potentials

Brainstem Auditory Evoked Potentials

Anurag Tewari MD

Surgical strategies towards the treatment of patients with symptomatic Chiari II malformations (CIIM) are favorable. Despite immediate evaluation and treatment with CSF shunt revision surgery, a significant population of CIIM patients requires hindbrain decompression. There is growing evidence for the utility of intraoperative electrophysiological studies, particularly combinatorial assessment with SSEPS and Tc-MEPs in spinal surgeries for brainstem compression and myelopathy, but scarce in the pediatric CIIM and myelodysplasia literature. Here, we report our use of a departmental IONM safety checklist and its efficacy in two cases of infants presenting with progressive brainstem dysfunction and long-tract signs CIIM hindbrain decompression.

Improved transcranial motor evoked potentials after craniovertebral decompres...

Improved transcranial motor evoked potentials after craniovertebral decompres...

Improved transcranial motor evoked potentials after craniovertebral decompres...

Anurag Tewari MD

Plus de Anurag Tewari MD (16)

Anesthesiology And Intraoperative Neurophysiological Monitoring

Anesthesiology And Intraoperative Neurophysiological Monitoring

Anesthesiology And Intraoperative Neurophysiological Monitoring

Intraoperative Flash Visual Evoked Potentials

Intraoperative Flash Visual Evoked Potentials

Intraoperative Flash Visual Evoked Potentials

ANAESTHETIC CONSIDERATION IN MACROGLOSSIA DUE TO LYMPHANGIOMA OF TONGUE

ANAESTHETIC CONSIDERATION IN MACROGLOSSIA DUE TO LYMPHANGIOMA OF TONGUE

ANAESTHETIC CONSIDERATION IN MACROGLOSSIA DUE TO LYMPHANGIOMA OF TONGUE

ANESTHETIC CONSIDERATIONS FOR STEREOTACTIC ELECTROENCEPHALOGRAPHY (SEEG) IMP...

ANESTHETIC CONSIDERATIONS FOR STEREOTACTIC ELECTROENCEPHALOGRAPHY (SEEG) IMP...

ANESTHETIC CONSIDERATIONS FOR STEREOTACTIC ELECTROENCEPHALOGRAPHY (SEEG) IMP...

CNIM Questions related to Mathematics and Formulas

CNIM Questions related to Mathematics and Formulas

CNIM Questions related to Mathematics and Formulas

Does IONM Help the Anesthesiologists?

Does IONM Help the Anesthesiologists?

Does IONM Help the Anesthesiologists?

A novel solution for drug error

A novel solution for drug error

A novel solution for drug error

Basic Anatomy for Trans-cranial Motor Evoked Potentials Monitoring

Basic Anatomy for Trans-cranial Motor Evoked Potentials Monitoring

Basic Anatomy for Trans-cranial Motor Evoked Potentials Monitoring

IONM for Carotid Surgery & Carotidendartectomy

IONM for Carotid Surgery & Carotidendartectomy

IONM for Carotid Surgery & Carotidendartectomy

IONM for Cerebellopontine Angle Tumor Surgery

IONM for Cerebellopontine Angle Tumor Surgery

IONM for Cerebellopontine Angle Tumor Surgery

Guideline 11B: RECOMMENDED STANDARDS FOR INTRAOPERATIVE MONITORING OF SOMATOS...

Guideline 11B: RECOMMENDED STANDARDS FOR INTRAOPERATIVE MONITORING OF SOMATOS...

Guideline 11B: RECOMMENDED STANDARDS FOR INTRAOPERATIVE MONITORING OF SOMATOS...

Intraoperative Electromyography (EMG)

Intraoperative Electromyography (EMG)

Intraoperative Electromyography (EMG)

Electronics and Intra Operative Neurophysiological Monitoring

Electronics and Intra Operative Neurophysiological Monitoring

Electronics and Intra Operative Neurophysiological Monitoring

Brainstem Auditory Evoked Potentials Part II

Brainstem Auditory Evoked Potentials Part II

Brainstem Auditory Evoked Potentials Part II

Brainstem Auditory Evoked Potentials

Brainstem Auditory Evoked Potentials

Brainstem Auditory Evoked Potentials

Improved transcranial motor evoked potentials after craniovertebral decompres...

Improved transcranial motor evoked potentials after craniovertebral decompres...

Improved transcranial motor evoked potentials after craniovertebral decompres...

Dernier

Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Available Call Mrs Leela Ji +91-8630512678 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in Lucknow 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 Lucknow 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 — 8630512678 !! Thank you for Visiting.

Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...

Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...

Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...

Lucknow Call Girls Just Call 👉👉8630512678 Top Class Call Girl Service Available Call Mrs Leela Ji +91-8630512678 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in Lucknow 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 Lucknow 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 — 8630512678 !! Thank you for Visiting.

Lucknow Call Girls Just Call 👉👉8630512678 Top Class Call Girl Service Available

Lucknow Call Girls Just Call 👉👉8630512678 Top Class Call Girl Service Available

Lucknow Call Girls Just Call 👉👉8630512678 Top Class Call Girl Service Available

Lucknow Call Girls Service { 9984666624 } ❤️VVIP ROCKY Call Girl in Lucknow Uttar Pradesh WhatsApp Chat : +91-9984666624 Get More Information About Lucknow Escorts Service Lucknow Escorts offer their services to their clients at any time of day or night - including sex, travel and tours. Contact them via telephone or the internet. Hire an escort as your movie partner, date or party companion - they're sure to exceed all your expectations. Girls available 24/7 make for great companions who offer sensual body massages and drinks/food service during your time together. Find one who fits with your personality or budget - these girls have you covered.

Lucknow Call Girls Service { 9984666624 } ❤️VVIP ROCKY Call Girl in Lucknow U...

Lucknow Call Girls Service { 9984666624 } ❤️VVIP ROCKY Call Girl in Lucknow U...

Lucknow Call Girls Service { 9984666624 } ❤️VVIP ROCKY Call Girl in Lucknow U...

ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx

ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx

ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx

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

Circulatory Shock, types and stages, compensatory mechanisms

Circulatory Shock, types and stages, compensatory mechanisms

Circulatory Shock, types and stages, compensatory mechanisms

MedicoseAcademics

These are simplified slides discussing the regulation of cardiac output and venous return. Learning objectives: 1. Comprehend the determinants of cardiac output and factors affecting cardiac output 2. Comprehend the factors affecting stroke volume and heart rate and total peripheral resistance 3. Identify the factors regulating venous return 4. Discuss the causes of high and low output cardiac failure 5. Enlist the functions of veins and recognise the significance of venous reservoirs Study Resources: 1. Chapter 20, Guyton and Hall Textbook of Medical Physiology, 14th edition 2. Chapter 30 and 32, Ganong’s Review of Medical Physiology, 26th edition 3. Chapter 10, Human Physiology by Lauralee Sherwood, 9th edition 4. Physiology, Cardiac Output - StatPearls https://www.ncbi.nlm.nih.gov/books/NBK470455/

Cardiac Output, Venous Return, and Their Regulation

Cardiac Output, Venous Return, and Their Regulation

Cardiac Output, Venous Return, and Their Regulation

MedicoseAcademics

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

Difference Between Skeletal Smooth and Cardiac Muscles

Difference Between Skeletal Smooth and Cardiac Muscles

Difference Between Skeletal Smooth and Cardiac Muscles

MedicoseAcademics

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

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

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

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

Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts service book now CALL WATTSAPP THE MOST BEAUTIFUL INDEPENDENT ESCORT CALL GIRL SERVICE, WE ARE PROVIDING GENUINE CALL GIRL SERVICE I AM A a NATURAL BRUNETTES, SLIM BODY, NATURAL LONG HAIR AND ALL TYPE OF HAIR IS A NATURAL BRUNETTE IN THE MOST BEAUTIFUL INDEPENDENT ESCORT GIRL I AM A NATURAL BRUNETTE WITH ROOM AND HOTEL AND A NATURAL BRUNETTE WITH A BODY MADE FOR SIN AND ALL TYPE OF ME ALL THE TIME I SEND YOU A HAIR, VERY SOCIABLE AND FUNNY, READY TO ENTERTAIN TO ENTERTAIN U AND MAKE FORGET ABOUT TO GET ENTERTAIN U AND MAKE FORGET ABOUT ALL THE PROBLEMS. LET'S HAVE A WONDERFUL TIME TOGETHER AND FORGET ABOUT EVERYTHING ALL TYPE SERVICE ENJOYMENT SAFE AND SECURE IN CALL OUT CALL HOME AND HOTEL ANYTIME AVAILABLE AND ALL TYPE SERVICE ENJOYMENT

Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...

Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...

Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...

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

Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available

Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available

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

Call Girls Wayanad Just Call 8250077686 Top Class Call Girl Service Available

Call Girls Wayanad Just Call 8250077686 Top Class Call Girl Service Available

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

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

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

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

Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Rajasthan Booking Details Are here 05-May-2024( Mj) Click On WhatsApp Chat +91-9521753030 Jaipur Escorts Make You Feel Like Royalty Jaipur Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion

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

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

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

👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi College Call Girls Virugambakkam No💰Advance Booking Details Are here: just visit website: https://www.loversbabe.com/ #Call Girl In Chennai, #Chennaicallgirls #CallgirlserviceChennai, #CallgirlsinChennai #locantoChennaicallgirls #Chennaicallgirls #Chennaicallgirlsimages #Chennaicallgirlskothrud #Chennaicallgirlslocanto #Chennaicallgirlsmobno #Chennaicallgirlsmobileno #Chennaicallgirlsmobilenumber #Chennaicallgirlspics #ChennaicallgirlsChennaiescorts #Chennaicallgirlsrates #Chennaicallgirlsservice #Chennaicallgirlsservices #Chennaicallgirlsskokka Click On WhatsApp Chat +91-7427069034 Chennai Escorts Make You Feel Like Royalty Chennai Escorts catering to high profile clients are available #S07 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completionx

👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...

👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...

👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...

❤️ Chandigarh Call Girls☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Chandigarh Call Girls Service ☎️ Call Girls In Chandigarh BEST CALL GIRL ESCORTS SERVICE IN CHANDIGARH CALL WATTSAPP 98151-579OO THE MOST BEAUTIFUL INDEPENDENT ESCORT CALL GIRL SERVICE In Chandigarh WE ARE PROVIDING GENUINE CALL GIRL SERVICE I AM A a NATURAL BRUNETTES, SLIM BODY, NATURAL LONG HAIR AND ALL TYPE OF HAIR IS A NATURAL BRUNETTE IN THE MOST BEAUTIFUL MODELS INDEPENDENT ESCORT GIRL I AM A NATURAL BRUNETTE WITH ROOM AND HOTEL AND A NATURAL BRUNETTE WITH A BODY MADE FOR SIN AND ALL TYPE OF ME ALL THE TIME I SEND YOU A HAIR, VERY SOCIABLE AND FUNNY, READY TO ENTERTAIN TO ENTERTAIN U AND MAKE FORGET ABOUT TO AGET ENTERTAINMENT YOU AND MAKE FORGET ABOUT ALL THE PROBLEMS. LET'S HAVE A WONDERFUL TIME TOGETHER AND FORGET ABOUT EVERYTHING ALL TYPE SERVICE ENJOYMENT SAFE AND SECURE IN CALL OUT CALL HOME AND HOTEL ANYTIME AVAILABLE AND ALL TYPE SERVICE ENJOYMENTPANCHKULA INDEPENDENT BEST CALL GIRL ESCORTS SERVICE IN PANCHKULA INDEPENDENT CALL GIRL Chandigarh Call Girls In Chandigarh BEST Call Girls in CHANDIGARH Escort Service provide Cute Nice sweet and Sexy Models in beautiful CHANDIGARH city cash in hand to hand call girl in CHANDIGARH and CHANDIGARH escorts. HOT & SEXY MODELS // COLLEGE GIRLS IN CHANDIGARH AVAILABLE FOR COMPLETE ENJOYMENT WITH HIGH PROFILE INDIAN MODEL AVAILABLE HOTEL & HOME ★ SAFE AND SECURE HIGH CLASS SERVICE AFFORDABLE RATE ★ 100% SATISFACTION,UNLIMITED ENJOYMENT. ★ All Meetings are confidential and no information is provided to any one at any cost. ★ EXCLUSIVE Profiles Are Safe and Consensual with Most Limits Respected ★ Service Available In: - HOME & 24x7 :: 3 * 5 *7 *Star Hotel Service .In Call & Out call Services : ★ A-Level (5 star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob)Receive advanced sexual techniques in different mode make their life more pleasurable. ★ Spending time in hotel rooms ★ BJ (Blowjob Without a Condom) ★ Completion (Oral to completion) ★ Covered (Covered blowjob Without a Condom)-❤️ Chandigarh Call Girls Service☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Chandigarh Call Girls Service ☎️ Call Girls In Chandigarh

❤️ Chandigarh Call Girls☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Ch...

❤️ Chandigarh Call Girls☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Ch...

❤️ Chandigarh Call Girls☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Ch...

Rashmi Entertainment

PEMESANAN OBAT ASLI : +6287776558899 Cara Menggugurkan Kandungan usia 1 , 2 , bulan - obat penggugur janin - cara aborsi kandungan - obat penggugur kandungan 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 bulan - bagaimana cara menggugurkan kandungan - tips Cara aborsi kandungan - trik Cara menggugurkan janin - Cara aman bagi ibu menyusui menggugurkan kandungan - klinik apotek jual obat penggugur kandungan - jamu PENGGUGUR KANDUNGAN - WAJIB TAU CARA ABORSI JANIN - GUGURKAN KANDUNGAN AMAN TANPA KURET - CARA Menggugurkan Kandungan tanpa efek samping - rekomendasi dokter obat herbal penggugur kandungan - ABORSI JANIN - aborsi kandungan - jamu herbal Penggugur kandungan - cara Menggugurkan Kandungan yang cacat - tata cara Menggugurkan Kandungan - obat penggugur kandungan di apotik kimia Farma - obat telat datang bulan - obat penggugur kandungan tuntas - obat penggugur kandungan alami - klinik aborsi janin gugurkan kandungan - ©Cytotec ™misoprostol BPOM - OBAT PENGGUGUR KANDUNGAN ®CYTOTEC - aborsi janin dengan pil ©Cytotec - ®Cytotec misoprostol® BPOM 100% - penjual obat penggugur kandungan asli - klinik jual obat aborsi janin - obat penggugur kandungan di klinik k-24 || obat penggugur ™Cytotec di apotek umum || ®CYTOTEC ASLI || obat ©Cytotec yang asli 200mcg || obat penggugur ASLI || pil Cytotec© tablet || cara gugurin kandungan || jual ®Cytotec 200mcg || dokter gugurkan kandungan || cara menggugurkan kandungan dengan cepat selesai dalam 24 jam secara alami buah buahan || usia kandungan 1_2 3_4 5_6 7_8 bulan masih bisa di gugurkan || obat penggugur kandungan ®cytotec dan gastrul || cara gugurkan pembuahan janin secara alami dan cepat || gugurkan kandungan || gugurin janin || cara Menggugurkan janin di luar nikah || contoh aborsi janin yang benar || contoh obat penggugur kandungan asli || contoh cara Menggugurkan Kandungan yang benar || telat haid || obat telat haid || Cara Alami gugurkan kehamilan || obat telat menstruasi || cara Menggugurkan janin anak haram || cara aborsi menggugurkan janin yang tidak berkembang || gugurkan kandungan dengan obat ©Cytotec || obat penggugur kandungan ™Cytotec 100% original || HARGA obat penggugur kandungan || obat telat haid 1 bulan || obat telat menstruasi 1-2 3-4 5-6 7-8 BULAN || obat telat datang bulan || cara Menggugurkan janin 1 bulan || cara Menggugurkan Kandungan yang masih 2 bulan || cara Menggugurkan Kandungan yang masih hitungan Minggu || cara Menggugurkan Kandungan yang masih usia 3 bulan || cara Menggugurkan usia kandungan 4 bulan || cara Menggugurkan janin usia 5 bulan || cara Menggugurkan kehamilan 6 Bulan ________&&&_________&&&_____________&&&_________&&&&____________ Cara Menggugurkan Kandungan Usia Janin 1 | 7 | 8 Bulan Dengan Cepat Dalam Hitungan Jam Secara Alami, Kami Siap Meneriman Pesanan Ke Seluruh Indonesia, Melputi: Ambon, Banda Aceh, Bandung, Banjarbaru, Batam, Bau-Bau, Bengkulu, Binjai, Blitar, Bontang, Cilegon, Cirebon, Depok, Gorontalo, Jakarta, Jayapura, Kendari, Kota Mobagu, Kupang, Lhokseumawe

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

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

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

Cara Menggugurkan Kandungan 087776558899

💞 Safe And Secure Call Girls Coimbatore🧿 6378878445 🧿 High Class Coimbatore Call Girl Service Available 6378878445 THE GENUINE ESCORT AGENCY VIP LUXURY CALL GIRLS HIGH CLASS MODELS CALL GIRLS GENUINE ESCORT BOOK BOOK APPOINTMENT - 6378878445 THE GENUINE ESCORT AGENCY BEST VIP CALL GIRLS & ESCORTS SERVICE 6378878445 VIP CALL GIRLS ALL TYPE WOMEN AVAILABLE INCALL & OUTCALL BOTH AVAILABLE BOOK NOW 6378878445 VIP GENUINE INDEPENDENT ESCORT AGENCY VIP PRIVATE AUNTIES BEAUTIFUL LOOKING HOT AND SEXT GIRLS AND PARTY TYPE GIRLS YOU WANT SERVICE THEN CALL THIS NUMBER 6378878445 ROOM ALSO PROVIDE HOME & HOTELS SERVICE FULL SAFE AND SECURE WORK WITHOUT CONDOMS, ORAL, SUCKING, LIP TO LIP, ANAL, BACK SHOTS, SEX 69, WITHOUT BLOWJOB AND MUCH MORE #v08-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 FOR BOOKING 6378878445

💞 Safe And Secure Call Girls Coimbatore🧿 6378878445 🧿 High Class Coimbatore C...

💞 Safe And Secure Call Girls Coimbatore🧿 6378878445 🧿 High Class Coimbatore C...

💞 Safe And Secure Call Girls Coimbatore🧿 6378878445 🧿 High Class Coimbatore C...

dilbirsingh0889

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

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

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

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

Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos and Number ★ CALL US High Class Luxury and Premium Escorts ServiCe We Provide Well Educated, Royal Class Female, High-Class Escorts Offering a Top High-Class Escorts Service In the & Several Nearby All Places Of . ★ Get The High Profile, Bollywood Queens , Well Educated , Good Looking , Full Cooperative Model Services. You Can See Me at My Comfortable Hotels or I Can Visit You In hotel Our Service Available IN All SERVICE, 3/4/5 STAR HOTEL , In Call /Out Call Services.24 hrs ,$P13 ★ To Enjoy With Hot and Sexy Girls . ★ We Are Providing :- • Models • Vip Models • Russian Models • Foreigner Models • TV Actress and Celebrities • Receptionist • Air Hostess • Call Center Working Girls/Women • Hi-Tech Co. Girls/Women • Housewife • Collage Going Girls. • Travelling Escorts. • Ramp-Models • Foreigner And Many More.. Incall & Outcall Available… • INDEPENDENT GIRLS / HOUSE WIFES ★ I Guarantee You To Have An Unforgettable Experience With Me.A Curvy Body, long Hair and Silky Smooth Skin. She Is an Independent Escorts Model Will Give You More Pleasure & Full Satisfaction. Call Now Seema:- 9332606886

Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos a...

Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos a...

Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos a...

call girls hydrabad

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

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

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

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

Dernier (20)

Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...

Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...

Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...

Lucknow Call Girls Just Call 👉👉8630512678 Top Class Call Girl Service Available

Lucknow Call Girls Just Call 👉👉8630512678 Top Class Call Girl Service Available

Lucknow Call Girls Just Call 👉👉8630512678 Top Class Call Girl Service Available

Lucknow Call Girls Service { 9984666624 } ❤️VVIP ROCKY Call Girl in Lucknow U...

Lucknow Call Girls Service { 9984666624 } ❤️VVIP ROCKY Call Girl in Lucknow U...

Lucknow Call Girls Service { 9984666624 } ❤️VVIP ROCKY Call Girl in Lucknow U...

ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx

ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx

ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx

Circulatory Shock, types and stages, compensatory mechanisms

Circulatory Shock, types and stages, compensatory mechanisms

Circulatory Shock, types and stages, compensatory mechanisms

Cardiac Output, Venous Return, and Their Regulation

Cardiac Output, Venous Return, and Their Regulation

Cardiac Output, Venous Return, and Their Regulation

Difference Between Skeletal Smooth and Cardiac Muscles

Difference Between Skeletal Smooth and Cardiac Muscles

Difference Between Skeletal Smooth and Cardiac Muscles

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

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

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

Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...

Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...

Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...

Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available

Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available

Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available

Call Girls Wayanad Just Call 8250077686 Top Class Call Girl Service Available

Call Girls Wayanad Just Call 8250077686 Top Class Call Girl Service Available

Call Girls Wayanad Just Call 8250077686 Top Class Call Girl Service Available

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

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

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

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

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

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

👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...

👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...

👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...

❤️ Chandigarh Call Girls☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Ch...

❤️ Chandigarh Call Girls☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Ch...

❤️ Chandigarh Call Girls☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Ch...

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

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

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

💞 Safe And Secure Call Girls Coimbatore🧿 6378878445 🧿 High Class Coimbatore C...

💞 Safe And Secure Call Girls Coimbatore🧿 6378878445 🧿 High Class Coimbatore C...

💞 Safe And Secure Call Girls Coimbatore🧿 6378878445 🧿 High Class Coimbatore C...

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

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

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

Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos a...

Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos a...

Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos a...

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

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

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

Filters in Intraoperative Neurophysiological Monitoring

1. Anurag Tewari MD Medsurant Health Academy B: Filters

2. Anurag Tewari MD Medsurant Health Academy

3. Anurag Tewari MD Medsurant Health Academy

4. Anurag Tewari MD Medsurant Health Academy

5. Anurag Tewari MD Medsurant Health Academy

6. Anurag Tewari MD Medsurant Health Academy

7. Anurag Tewari MD Medsurant Health Academy

8. Anurag Tewari MD Medsurant Health Academy

9. Anurag Tewari MD Medsurant Health Academy

10. Anurag Tewari MD Medsurant Health Academy

11. Anurag Tewari MD Medsurant Health Academy

12. Anurag Tewari MD Medsurant Health Academy

13. Anurag Tewari MD Medsurant Health Academy

14. Anurag Tewari MD Medsurant Health Academy

15. Anurag Tewari MD Medsurant Health Academy

16. Anurag Tewari MD Medsurant Health Academy

17. Anurag Tewari MD Medsurant Health Academy

18. Anurag Tewari MD Medsurant Health Academy

19. Anurag Tewari MD Medsurant Health Academy

20. Anurag Tewari MD Medsurant Health Academy

21. Anurag Tewari MD Medsurant Health Academy

22. Anurag Tewari MD Medsurant Health Academy

23. Anurag Tewari MD Medsurant Health Academy

24. Anurag Tewari MD Medsurant Health Academy

25. Anurag Tewari MD Medsurant Health Academy

26. Anurag Tewari MD Medsurant Health Academy

27. Anurag Tewari MD Medsurant Health Academy

28. Anurag Tewari MD Medsurant Health Academy

29. Anurag Tewari MD Medsurant Health Academy

30. AnuragTewariMD Anurag Tewari MD Resources Anurag Tewari MD 30 What is an operational amplifier? Inverting op-amp circuit Non-inverting op-amp circuit