SlideShare une entreprise Scribd logo
1  sur  40
Assessment of Spinal Injury Stephen Schutts, Master Sergeant, WA ANG National Registry Emergency Medical Technician - Paramedic
Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object]
Objectives ,[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object],[object Object]
Mechanism based assessment (the current method) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy & Physiology- General Structure & Function ,[object Object],[object Object],[object Object],[object Object]
 
Anatomy & Physiology-“Long Bone” ,[object Object],[object Object],[object Object],[object Object]
Anatomy & Physiology- Cervical Spine (7) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
C-1 “Atlas” C-2 “Axis” ,[object Object],[object Object],[object Object]
Anatomy & Physiology- Thoracic Spine (12) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Anatomy & Physiology- Lumbosacral Spine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Anatomy & Physiology- Spinal Cord ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Mechanism of Injury ,[object Object],[object Object],[object Object],[object Object]
Hyperflexion
Hyperextension
Hyperotation
Axial Loading
Axial Distraction
Sudden/Extreme Lateral Bending ,[object Object],[object Object],[object Object],[object Object]
Spinal Column Injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spinal Cord Injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary Spinal Cord Injury ,[object Object],[object Object],[object Object],[object Object]
Secondary Spinal  Cord Injury ,[object Object],[object Object],[object Object],[object Object]
Incomplete Spinal Cord Injury ,[object Object],[object Object],[object Object]
Spinal Region Overview ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cervical Spine Injuries ,[object Object],[object Object],[object Object],[object Object]
Thoracic Spine Injuries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lumbosacral Spine Injuries ,[object Object],[object Object],[object Object],[object Object],[object Object]
Assessment Overview ,[object Object],[object Object],[object Object]
Spinal Immobilization  Algorithm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Principles of Treatment ,[object Object],[object Object],[object Object],[object Object]
Complete Spinal Immobilization ,[object Object],[object Object],[object Object],[object Object]
Common Treatment/Management Mistakes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Common Treatment/Management Mistakes (cont.) ,[object Object],[object Object],[object Object]
Any Questions???

Contenu connexe

Tendances

Cervical Fractures and Cervical spine injuries - Dr.KK
Cervical Fractures and Cervical spine injuries  - Dr.KKCervical Fractures and Cervical spine injuries  - Dr.KK
Cervical Fractures and Cervical spine injuries - Dr.KKQueen Mary Hospital
 
Traumatic brain injury
Traumatic brain injuryTraumatic brain injury
Traumatic brain injurymarwa Mahrous
 
Traumatic brain injury
Traumatic brain injuryTraumatic brain injury
Traumatic brain injuryzuni1412
 
management of spinal cord injury
management of spinal cord injurymanagement of spinal cord injury
management of spinal cord injuryadewumi adeagbo
 
Spinal injury gihs
Spinal injury   gihsSpinal injury   gihs
Spinal injury gihsgangahealth
 
Cervical trauma
Cervical traumaCervical trauma
Cervical traumaAli Jiwani
 
Cervical spine injuries
Cervical spine injuries Cervical spine injuries
Cervical spine injuries Sj Karthik
 
Evaluation of Spinal Injury & Emergency Management
Evaluation of Spinal Injury & Emergency ManagementEvaluation of Spinal Injury & Emergency Management
Evaluation of Spinal Injury & Emergency ManagementAtif Shahzad
 
Head injury
Head injuryHead injury
Head injurySuhas U
 
Spinal injuries (compiled by Dr Sanjib Kumar Das)
Spinal injuries (compiled by Dr Sanjib Kumar Das)Spinal injuries (compiled by Dr Sanjib Kumar Das)
Spinal injuries (compiled by Dr Sanjib Kumar Das)Dr. Sanjib Kumar Das
 
Posterior shoulder dislocation 2
Posterior shoulder dislocation 2Posterior shoulder dislocation 2
Posterior shoulder dislocation 2Shoulder Library
 
Cervical spine fracture radiology, classification and management
Cervical spine fracture radiology, classification and management Cervical spine fracture radiology, classification and management
Cervical spine fracture radiology, classification and management AshrafJamal12
 
spinal cord injury
spinal cord injuryspinal cord injury
spinal cord injuryLQMN ADLEE
 

Tendances (20)

Cervical Fractures and Cervical spine injuries - Dr.KK
Cervical Fractures and Cervical spine injuries  - Dr.KKCervical Fractures and Cervical spine injuries  - Dr.KK
Cervical Fractures and Cervical spine injuries - Dr.KK
 
Spine injury
Spine injurySpine injury
Spine injury
 
Thoraco lumbar fractures
Thoraco lumbar fracturesThoraco lumbar fractures
Thoraco lumbar fractures
 
Clavicle fracture
Clavicle fractureClavicle fracture
Clavicle fracture
 
Traumatic brain injury
Traumatic brain injuryTraumatic brain injury
Traumatic brain injury
 
Spinal trauma
Spinal traumaSpinal trauma
Spinal trauma
 
Spinal cord injury
Spinal cord injurySpinal cord injury
Spinal cord injury
 
Traumatic brain injury
Traumatic brain injuryTraumatic brain injury
Traumatic brain injury
 
management of spinal cord injury
management of spinal cord injurymanagement of spinal cord injury
management of spinal cord injury
 
Spinal injury gihs
Spinal injury   gihsSpinal injury   gihs
Spinal injury gihs
 
Cervical trauma
Cervical traumaCervical trauma
Cervical trauma
 
SPiNAL INJURY AND IT'S CURRENT MANAGEMENT : CME -
SPiNAL INJURY AND IT'S CURRENT MANAGEMENT : CME  -SPiNAL INJURY AND IT'S CURRENT MANAGEMENT : CME  -
SPiNAL INJURY AND IT'S CURRENT MANAGEMENT : CME -
 
Cervical spine injuries
Cervical spine injuries Cervical spine injuries
Cervical spine injuries
 
Evaluation of Spinal Injury & Emergency Management
Evaluation of Spinal Injury & Emergency ManagementEvaluation of Spinal Injury & Emergency Management
Evaluation of Spinal Injury & Emergency Management
 
‫Spinal injury
‫Spinal injury   ‫Spinal injury
‫Spinal injury
 
Head injury
Head injuryHead injury
Head injury
 
Spinal injuries (compiled by Dr Sanjib Kumar Das)
Spinal injuries (compiled by Dr Sanjib Kumar Das)Spinal injuries (compiled by Dr Sanjib Kumar Das)
Spinal injuries (compiled by Dr Sanjib Kumar Das)
 
Posterior shoulder dislocation 2
Posterior shoulder dislocation 2Posterior shoulder dislocation 2
Posterior shoulder dislocation 2
 
Cervical spine fracture radiology, classification and management
Cervical spine fracture radiology, classification and management Cervical spine fracture radiology, classification and management
Cervical spine fracture radiology, classification and management
 
spinal cord injury
spinal cord injuryspinal cord injury
spinal cord injury
 

En vedette

Spinal cord injury
Spinal cord injurySpinal cord injury
Spinal cord injuryHardik Pawar
 
Spinal cord injury presentation
Spinal cord injury presentationSpinal cord injury presentation
Spinal cord injury presentationsshssomsen
 
Spinal cord injury (sci) Rehab
Spinal cord injury (sci) RehabSpinal cord injury (sci) Rehab
Spinal cord injury (sci) RehabQuan Fu Gan
 
Spinal cord injuries
Spinal cord injuriesSpinal cord injuries
Spinal cord injuriesSCGH ED CME
 
Presentation1.pptx, radiological imaging of spinal trauma and spinal cord inj...
Presentation1.pptx, radiological imaging of spinal trauma and spinal cord inj...Presentation1.pptx, radiological imaging of spinal trauma and spinal cord inj...
Presentation1.pptx, radiological imaging of spinal trauma and spinal cord inj...Abdellah Nazeer
 
Spinal cord disorders
Spinal cord disordersSpinal cord disorders
Spinal cord disordersEM OMSB
 
Spinal cord lesions module
Spinal cord lesions moduleSpinal cord lesions module
Spinal cord lesions moduleHarun Muhammad
 
Nursing care of the patient with sci
Nursing care of the patient with sciNursing care of the patient with sci
Nursing care of the patient with sciMatthew Rollosson
 
Seminar on head injury and spinal cord injury
Seminar on head injury and spinal cord injurySeminar on head injury and spinal cord injury
Seminar on head injury and spinal cord injuryUma Binoy
 
Presentation1.pptx, radiological imaging of spinal cord tumour.
Presentation1.pptx, radiological imaging of spinal cord tumour.Presentation1.pptx, radiological imaging of spinal cord tumour.
Presentation1.pptx, radiological imaging of spinal cord tumour.Abdellah Nazeer
 
Spinal shock
Spinal shockSpinal shock
Spinal shocksnich
 
Localizaiton of level of lesion in paraplegia
Localizaiton of level of lesion in paraplegiaLocalizaiton of level of lesion in paraplegia
Localizaiton of level of lesion in paraplegiaAbino David
 
Anatomy of spinal cord
Anatomy of spinal cordAnatomy of spinal cord
Anatomy of spinal cordMBBS IMS MSU
 

En vedette (20)

Spinal injury ppt
Spinal injury pptSpinal injury ppt
Spinal injury ppt
 
Spinal cord injury
Spinal cord injurySpinal cord injury
Spinal cord injury
 
Spinal cord injury presentation
Spinal cord injury presentationSpinal cord injury presentation
Spinal cord injury presentation
 
Spinal Cord Injury
Spinal Cord InjurySpinal Cord Injury
Spinal Cord Injury
 
Spinal cord injury (sci) Rehab
Spinal cord injury (sci) RehabSpinal cord injury (sci) Rehab
Spinal cord injury (sci) Rehab
 
Spinal cord injuries
Spinal cord injuriesSpinal cord injuries
Spinal cord injuries
 
Presentation1.pptx, radiological imaging of spinal trauma and spinal cord inj...
Presentation1.pptx, radiological imaging of spinal trauma and spinal cord inj...Presentation1.pptx, radiological imaging of spinal trauma and spinal cord inj...
Presentation1.pptx, radiological imaging of spinal trauma and spinal cord inj...
 
Spinal cord disorders
Spinal cord disordersSpinal cord disorders
Spinal cord disorders
 
Spinal cord lesions module
Spinal cord lesions moduleSpinal cord lesions module
Spinal cord lesions module
 
Syndromes Of Spinal Cord
Syndromes Of Spinal CordSyndromes Of Spinal Cord
Syndromes Of Spinal Cord
 
Nursing care of the patient with sci
Nursing care of the patient with sciNursing care of the patient with sci
Nursing care of the patient with sci
 
Seminar on head injury and spinal cord injury
Seminar on head injury and spinal cord injurySeminar on head injury and spinal cord injury
Seminar on head injury and spinal cord injury
 
Presentation1.pptx, radiological imaging of spinal cord tumour.
Presentation1.pptx, radiological imaging of spinal cord tumour.Presentation1.pptx, radiological imaging of spinal cord tumour.
Presentation1.pptx, radiological imaging of spinal cord tumour.
 
Spinal Cord Syndrome
Spinal Cord SyndromeSpinal Cord Syndrome
Spinal Cord Syndrome
 
Spinal shock
Spinal shockSpinal shock
Spinal shock
 
Spinal cord syndromes
Spinal cord syndromesSpinal cord syndromes
Spinal cord syndromes
 
Spinal shock
Spinal shockSpinal shock
Spinal shock
 
Localizaiton of level of lesion in paraplegia
Localizaiton of level of lesion in paraplegiaLocalizaiton of level of lesion in paraplegia
Localizaiton of level of lesion in paraplegia
 
Anatomy of spinal cord
Anatomy of spinal cordAnatomy of spinal cord
Anatomy of spinal cord
 
Biomechanics of spine
Biomechanics of  spineBiomechanics of  spine
Biomechanics of spine
 

Similaire à Spinal Injury

Lavc Health 12 First Aid Muscles Bones Joints Injuries Spring 2007
Lavc Health 12 First Aid Muscles Bones Joints Injuries Spring 2007Lavc Health 12 First Aid Muscles Bones Joints Injuries Spring 2007
Lavc Health 12 First Aid Muscles Bones Joints Injuries Spring 2007Patty Melody
 
2017_Brent_Feland_PDF_Presentation.pdf
2017_Brent_Feland_PDF_Presentation.pdf2017_Brent_Feland_PDF_Presentation.pdf
2017_Brent_Feland_PDF_Presentation.pdfHassanJaved694664
 
Lumber disc bulge/ Herniation/ Prolapse
Lumber disc bulge/ Herniation/ ProlapseLumber disc bulge/ Herniation/ Prolapse
Lumber disc bulge/ Herniation/ ProlapseDr. Zunaira Ahmad
 
CME SPINAL INJURY.pptx
CME SPINAL INJURY.pptxCME SPINAL INJURY.pptx
CME SPINAL INJURY.pptxmieyoi
 
dislocation and subluxation 3.ppt
dislocation and subluxation 3.pptdislocation and subluxation 3.ppt
dislocation and subluxation 3.pptsidra234490
 
dislocationandsubluxation3-230302112416-8b54cbd9.pdf
dislocationandsubluxation3-230302112416-8b54cbd9.pdfdislocationandsubluxation3-230302112416-8b54cbd9.pdf
dislocationandsubluxation3-230302112416-8b54cbd9.pdfAugustusCaesar7
 
Spinal cord injuries spinalfractures thoracolumbar fracture
Spinal cord injuries spinalfractures thoracolumbar fractureSpinal cord injuries spinalfractures thoracolumbar fracture
Spinal cord injuries spinalfractures thoracolumbar fractureNabil Khalil
 
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MDCervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MDPablo Pazmino
 
Sci Presentation
Sci PresentationSci Presentation
Sci Presentationmycomic
 
Kin 188 Knee Injuries And Evaluation
Kin 188   Knee Injuries And EvaluationKin 188   Knee Injuries And Evaluation
Kin 188 Knee Injuries And EvaluationJLS10
 

Similaire à Spinal Injury (20)

C & p chapter 7
C & p chapter 7C & p chapter 7
C & p chapter 7
 
Hip dislocation
 Hip dislocation Hip dislocation
Hip dislocation
 
Lavc Health 12 First Aid Muscles Bones Joints Injuries Spring 2007
Lavc Health 12 First Aid Muscles Bones Joints Injuries Spring 2007Lavc Health 12 First Aid Muscles Bones Joints Injuries Spring 2007
Lavc Health 12 First Aid Muscles Bones Joints Injuries Spring 2007
 
Back injury
Back injuryBack injury
Back injury
 
2017_Brent_Feland_PDF_Presentation.pdf
2017_Brent_Feland_PDF_Presentation.pdf2017_Brent_Feland_PDF_Presentation.pdf
2017_Brent_Feland_PDF_Presentation.pdf
 
CME Orthopedic.pptx
CME Orthopedic.pptxCME Orthopedic.pptx
CME Orthopedic.pptx
 
Lumber disc bulge/ Herniation/ Prolapse
Lumber disc bulge/ Herniation/ ProlapseLumber disc bulge/ Herniation/ Prolapse
Lumber disc bulge/ Herniation/ Prolapse
 
CME SPINAL INJURY.pptx
CME SPINAL INJURY.pptxCME SPINAL INJURY.pptx
CME SPINAL INJURY.pptx
 
dislocation and subluxation 3.ppt
dislocation and subluxation 3.pptdislocation and subluxation 3.ppt
dislocation and subluxation 3.ppt
 
dislocationandsubluxation3-230302112416-8b54cbd9.pdf
dislocationandsubluxation3-230302112416-8b54cbd9.pdfdislocationandsubluxation3-230302112416-8b54cbd9.pdf
dislocationandsubluxation3-230302112416-8b54cbd9.pdf
 
Low back pain
Low back painLow back pain
Low back pain
 
Spinal cord injuries spinalfractures thoracolumbar fracture
Spinal cord injuries spinalfractures thoracolumbar fractureSpinal cord injuries spinalfractures thoracolumbar fracture
Spinal cord injuries spinalfractures thoracolumbar fracture
 
Spine Powerpoint.ppt
Spine Powerpoint.pptSpine Powerpoint.ppt
Spine Powerpoint.ppt
 
Spine Powerpoint.ppt
Spine Powerpoint.pptSpine Powerpoint.ppt
Spine Powerpoint.ppt
 
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MDCervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
 
Spondylolisthesis neel.pptx
Spondylolisthesis neel.pptxSpondylolisthesis neel.pptx
Spondylolisthesis neel.pptx
 
Sci Presentation
Sci PresentationSci Presentation
Sci Presentation
 
Kin 188 Knee Injuries And Evaluation
Kin 188   Knee Injuries And EvaluationKin 188   Knee Injuries And Evaluation
Kin 188 Knee Injuries And Evaluation
 
The spine & spinal cord
The spine & spinal cordThe spine & spinal cord
The spine & spinal cord
 
Common pitfalls in orthopedics
Common pitfalls in orthopedicsCommon pitfalls in orthopedics
Common pitfalls in orthopedics
 

Plus de Narenthorn EMS Center

CPR2015 update: ACS and Special circumstances
CPR2015 update: ACS and Special circumstancesCPR2015 update: ACS and Special circumstances
CPR2015 update: ACS and Special circumstancesNarenthorn EMS Center
 
CPR2015 update: BLS, CPR Quality and First aid
CPR2015 update: BLS, CPR Quality and First aidCPR2015 update: BLS, CPR Quality and First aid
CPR2015 update: BLS, CPR Quality and First aidNarenthorn EMS Center
 
การอำนวยความสะดวกการจราจรระหว่างการซ้อมแผน
การอำนวยความสะดวกการจราจรระหว่างการซ้อมแผนการอำนวยความสะดวกการจราจรระหว่างการซ้อมแผน
การอำนวยความสะดวกการจราจรระหว่างการซ้อมแผนNarenthorn EMS Center
 
Team dynamic for Advanced life support checklist
Team dynamic for Advanced life support checklistTeam dynamic for Advanced life support checklist
Team dynamic for Advanced life support checklistNarenthorn EMS Center
 
Trauma Initial assessment and Resuscitation
Trauma Initial assessment and ResuscitationTrauma Initial assessment and Resuscitation
Trauma Initial assessment and ResuscitationNarenthorn EMS Center
 
การยกและการเคลื่อนย้ายผู้ป่วย
การยกและการเคลื่อนย้ายผู้ป่วยการยกและการเคลื่อนย้ายผู้ป่วย
การยกและการเคลื่อนย้ายผู้ป่วยNarenthorn EMS Center
 
Neonatal resuscitation การช่วยฟื้นชีวิตทารกและทารกแรกเกิด
Neonatal resuscitation การช่วยฟื้นชีวิตทารกและทารกแรกเกิดNeonatal resuscitation การช่วยฟื้นชีวิตทารกและทารกแรกเกิด
Neonatal resuscitation การช่วยฟื้นชีวิตทารกและทารกแรกเกิดNarenthorn EMS Center
 

Plus de Narenthorn EMS Center (20)

First aid by Narenthorn 2016
First aid by Narenthorn 2016First aid by Narenthorn 2016
First aid by Narenthorn 2016
 
CPR2015 update: ACS and Special circumstances
CPR2015 update: ACS and Special circumstancesCPR2015 update: ACS and Special circumstances
CPR2015 update: ACS and Special circumstances
 
CPR2015 update: PBLS
CPR2015 update: PBLSCPR2015 update: PBLS
CPR2015 update: PBLS
 
CPR2015 update: Adult ACLS
CPR2015 update: Adult ACLSCPR2015 update: Adult ACLS
CPR2015 update: Adult ACLS
 
CPR2015 update: PALS
CPR2015 update: PALSCPR2015 update: PALS
CPR2015 update: PALS
 
Neonatal resuscitation 2015
Neonatal resuscitation 2015Neonatal resuscitation 2015
Neonatal resuscitation 2015
 
CPR2015 update: BLS, CPR Quality and First aid
CPR2015 update: BLS, CPR Quality and First aidCPR2015 update: BLS, CPR Quality and First aid
CPR2015 update: BLS, CPR Quality and First aid
 
CPR2015 update: Ethical issues
CPR2015 update: Ethical issuesCPR2015 update: Ethical issues
CPR2015 update: Ethical issues
 
การอำนวยความสะดวกการจราจรระหว่างการซ้อมแผน
การอำนวยความสะดวกการจราจรระหว่างการซ้อมแผนการอำนวยความสะดวกการจราจรระหว่างการซ้อมแผน
การอำนวยความสะดวกการจราจรระหว่างการซ้อมแผน
 
Acute coronary syndrome 2010
Acute coronary syndrome 2010Acute coronary syndrome 2010
Acute coronary syndrome 2010
 
Team dynamic for Advanced life support checklist
Team dynamic for Advanced life support checklistTeam dynamic for Advanced life support checklist
Team dynamic for Advanced life support checklist
 
Acute Stroke 2010
Acute Stroke 2010Acute Stroke 2010
Acute Stroke 2010
 
ACLS 2010
ACLS 2010ACLS 2010
ACLS 2010
 
Trauma Initial assessment and Resuscitation
Trauma Initial assessment and ResuscitationTrauma Initial assessment and Resuscitation
Trauma Initial assessment and Resuscitation
 
PALS 2010
PALS 2010PALS 2010
PALS 2010
 
EKG in ACLS
EKG in ACLSEKG in ACLS
EKG in ACLS
 
การยกและการเคลื่อนย้ายผู้ป่วย
การยกและการเคลื่อนย้ายผู้ป่วยการยกและการเคลื่อนย้ายผู้ป่วย
การยกและการเคลื่อนย้ายผู้ป่วย
 
Neonatal resuscitation การช่วยฟื้นชีวิตทารกและทารกแรกเกิด
Neonatal resuscitation การช่วยฟื้นชีวิตทารกและทารกแรกเกิดNeonatal resuscitation การช่วยฟื้นชีวิตทารกและทารกแรกเกิด
Neonatal resuscitation การช่วยฟื้นชีวิตทารกและทารกแรกเกิด
 
Airway workshop Reading material
Airway workshop Reading materialAirway workshop Reading material
Airway workshop Reading material
 
APHLS & EMS director 2011 Exam
APHLS & EMS director 2011 ExamAPHLS & EMS director 2011 Exam
APHLS & EMS director 2011 Exam
 

Dernier

Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls JaipurCall Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipurparulsinha
 
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipur
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls JaipurRussian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipur
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipurparulsinha
 
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
 
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...narwatsonia7
 
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
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...narwatsonia7
 
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
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...chandars293
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Servicevidya singh
 
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Call Girls in Nagpur High Profile
 
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 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
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...CALL GIRLS
 
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
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...chandars293
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...jageshsingh5554
 

Dernier (20)

Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls JaipurCall Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
 
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipur
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls JaipurRussian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipur
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipur
 
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...
 
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
 
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...
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
 
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 ...
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
 
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
 
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 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 ...
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
 
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...
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
 

Spinal Injury

Notes de l'éditeur

  1. Policy # 6016.1