Phil hyde: Paeds Sim - Not for Dummies

•

2 likes•2,054 views

This document discusses pediatric simulation training and critical care education. It acknowledges contributors to the field and emphasizes integration and collaboration across specialties. The document outlines the patient journey from injury to rehabilitation and stresses the importance of multi-professional education from undergraduate to post-graduate levels. It promotes using simulated pediatric patients and families to engage clinicians and advocates for primary injury prevention. The document poses questions and challenges educators to train healthcare professionals in teams using simulated patients from the start of their education.

Health & Medicine

Acknowledgements
• Carrie Hamilton, Gill Clark
• Kim Sykes, Jill Thistlethwaite
• Kate Pryde
• Mike Eddie, Owen Hammett, Ed Langford, Emily
Cooper
• Claire Mcaleer, Clarissa Quinell

Primary
prevention
Pre-hospital
care
Hospital
Trauma
care
Intensive care
+/-
neurosurgery
Rehabilitation
services
Child is
injured
Return to
education
Children’s
rehabilitation
services

Primary
prevention
Pre-hospital
care
Hospital
Trauma
care
Intensive care
+/-
neurosurgery

Post-graduate education
DoctorsParamedicsNurses
Critical care

Critical care
Post-graduate multi-professional
critical care education

Critical care
Under-graduate education
DoctorsParamedicsNurses
Post-graduate multi-professional
critical care education

Critical care
Post-graduate multi-professional
critical care education
Under-graduate multi-professional
critical care education

Critical care
Post-graduate and
undergraduate
multi-professional
critical care education

Wessex inter-professional
critical care programme
www.wessexCCP.org

Children engage clinicians
like
no other technology

Critical care
Children
Families
Post-graduate and
undergraduate
multi-professional
critical care education

Primary
prevention
Critical care
Post-graduate and
undergraduate
multi-professional
critical care education
Children
Families

Children as simulated patients
Woodward CA, Gliva-McConvey G. Children as standardized patients:
initial assessment of effects. Teach Learn Med1995; 7:188–91

McConnell MM, Eva KW The role of emotion in the learning and transfer of
clinical skills and knowledge. Acad Med. 2012 Oct;87(10):1316-22.
When we care, we remember

Traumatic deaths per 100,000
children
Sweden 5.2
UK 6.1
Australia 9.5
Canada 9.7
USA 14.1
UNICEF, A league table of child deaths by injury in rich nations, 2001

Choose to rid your society
of the man made disease
called trauma

Challenges for SMACC
Train in teams – from students onwards
Include students in clinician training
Include simulated patients in your training
Make primary prevention real

Questions?
phil.hyde@uhs.nhs.uk
#philhyde_1
#mocisphere

Viewers also liked

The management of the septic patient in ICU is a recurrent topic for debate amongst intensivists. The decision of if and/or when to give blood transfusions is one of the key sources of contention. Dr Anders Perner is one of the most qualified people to weigh in on this debate. In this talk from SMACC Chicago, he delivers his stance on when to pull the transfusion trigger. Dr Anders Perner is an Intensive Care Specialist at Rigshospitalet and a professor in intensive care at Copenhagen University. He is the chairman of the Scandinavian Critical Care Trials Group and the strategic research program “New resuscitation strategies in patients with severe sepsis’. The contents of this talk are based on the findings of the TRISS trial - Transfusion Requirements in Septic Shock. This trial, Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock was published in the NEJM in October 2014. The aim was to evaluate the recommendations from the Surviving Sepsis Campaign regarding transfusion in septic shock. The recommendation is that after the first 6 hours, transfusion threshold should be a Hb <7g /></9g></ 9g/dL) or a lower transfusion threshold group (Hb</ 7g/dL). They each received 1 unit of leukoreduced PRBC when they reached their respective transfusion threshold. The primary outcome was death within 90 days of randomisation. In this SMACC talk, some of the key findings and limitations of the trial are discussed. So check out this talk and then read the full article available here to see if you agree with 7g/dL – the new normal. What’s your transfusion trigger? Is it time to rethink it?

Anders Perner - When to Pull the Transfusion Trigger?

SMACC Conference

BCC4: Lockie on Resuscitating the Lungs

SMACC Conference

Trish Woods guides you through some clinical pearls in the intensive care management of neonates. The complex physiology of the transitioning required in the journey from foetal life to neonatal presents many challenges and scary moments. Trish helps you to navigate these challenges and to unlock the key to providing quality neonatal intensive care. Many things can go wrong in the neonatal period as babies transition to life in the real world. Trish highlights her thoughts on the use of positive end expiratory pressure (PEEP), how deep to intubate, when to clamp the cord and the use of ultrasound. When babies arrive early their lungs can be full of meconium or fluid. Due to this, Trish recommends using PEEP – without which there is distal airway collapse and fluid accumulation. Aeration of the lungs is vital. To this end, how deep should intubation be aimed? The depth may not be overly important. This is because regional lung aeration triggers widespread, global increase in pulmonary blood flow. There is little definitive evidence to guide clinicians on when to clamp the cord – early or late. Trish recommends considering the physiology of clamping the cord. After clamping the cord there is a massive drop in cardiac output. Ventilatory support will turn this around – something to remember. In a compromised baby, perhaps we should aim to clamp the cord sooner and then initiate ventilation. Finally, Trish highlights the utility of ultrasound. Viewing the heart and lungs provides crucial information for the clinician. Furthermore, Trish discusses actively looking for aeration, collapse, consolidation and pneumothorax in the lungs and thorax. Overall, don’t forget the essentials. Trish reminds you to keep life sweet, warm, and tempting and help neonates to transition into the big world. Neonatal Intensive Care: Trish Woods For more like this, head to our podcast page. #CodaPodcast

Neonatal Intensive Care: Trish Woods

SMACC Conference

Ah, but you don't look like a professor! A recent statement from a (female) patient says it all, doesn't it? Since the first women were admitted to medical schools – quite a while ago in most countries, the participation of women in clinical and academic medicine has increased steadily. Overall, women represent the majority of health care workers and also medical students in most countries of the world today. SMACC audience is almost 50% female. However, only few women make it to the top, and with each step up the career ladder, the proportion of women decreases substantially, a phenomenon called the “glass ceiling” or the „leaky pipeline“. This is particularly true for some medical specialties such as critical care or trauma surgery, as opposed to specialties like endocrinology, pediatrics or gynecology. Although often subtle, gender discrimination against women continues to be a problem – for instance, it has been shown that a ficticious student named “John” would receive a higher salary and find a mentor easier than “Jennifer”. A manuscript written by “John” is judged more favourably than one that is authored by “Joan”, and female grant applicants with the same scientific productivity are given substantially lower scores than male applicants by reviewers (men and women). Sheryl Sandberg’s statements are as true in clinical and academic medicine as in other areas. This talk will definitely raise your awareness for the topic.

Critical Care: No place for a woman?

SMACC Conference

Crowe — Swearing Your Way Out of a Crisis

SMACC Conference

Fran Lockie is a Paediatric Emergency and Retrieval physician currently based in Adelaide. He is quickly becoming a leading expert in paediatric TBI and so was the perfect person to give this talk. The audio that goes with these slides is on Intensive Care Network (www.intensivecarenetwork.com). If you like these sorts of presentations, come to Cairns Bedside Critical care this September where we've got a great line up of speakers and we're doing it all again.

Fran Lockie on Paediatric TBI

SMACC Conference

Spiders and Stingers

precordialthump

Kathryn maitland vs nick pigott: forget physiology- cautious fluids save lives

SMACC Conference

Pht good, bad and ugly.key

waintensivecarenetwork

Soaring Over the Safety Chasm

Steve Harden

15 trauma care systems

Dang Thanh Tuan

ICN Victoria: Buck on "Resus Room Management"

Intensive Care Network Victoria

Emergency room nurse kpi

ratasjommi

Leading Teams in Healthcare

Abdel-Halim Mahmoud

TEAMWORK IN EMERGENCY DEPARTMENT

All India Institute of Medical Sciences

Top teaming tactics - from in to win -- v8 -- comptroller of currency

Judy Bradt

BCC4: Lockie on Little Adults

SMACC Conference

Management of polytraumatized patients

hosam hamza

Blood, but not as we know it: blood substitutes by Holley

SMACC Conference

Good medical practice 29 mac 2016

Lee Oi Wah

Viewers also liked (20)

Anders Perner - When to Pull the Transfusion Trigger?

BCC4: Lockie on Resuscitating the Lungs

Neonatal Intensive Care: Trish Woods

Critical Care: No place for a woman?

Crowe — Swearing Your Way Out of a Crisis

Fran Lockie on Paediatric TBI

Spiders and Stingers

Kathryn maitland vs nick pigott: forget physiology- cautious fluids save lives

Pht good, bad and ugly.key

Soaring Over the Safety Chasm

15 trauma care systems

ICN Victoria: Buck on "Resus Room Management"

Emergency room nurse kpi

Leading Teams in Healthcare

TEAMWORK IN EMERGENCY DEPARTMENT

Top teaming tactics - from in to win -- v8 -- comptroller of currency

BCC4: Lockie on Little Adults

Management of polytraumatized patients

Blood, but not as we know it: blood substitutes by Holley

Good medical practice 29 mac 2016

Similar to Phil hyde: Paeds Sim - Not for Dummies

Bronwyn Avard - Getting Your Foot In The Door

SMACC Conference

Settings of pediatric illness care delivery

Reynel Dan

Midwifery Presentation by Triangle Midwives

Sharon Delaney McCloud, Digital/Video Marketing

Wekerle CIHR Team - Picturing Wellness: From Adversity to Resilience

Christine Wekerle

Learn about medical services offered within the student health clinic and additional community resources available to provide a comprehensive scope of care for your student. The student health clinic offers care for urgent/episodic needs as well as an adjunct for primary care needs. This session will also cover how the student can access his/her electronic medical record “MYCHART”, instructions for waiving the preassigned insurance coverage, and how to complete the online required medical and vaccination history forms.

Student Health Services Breakout Session

Mark Pontious

Dr Lisa Hinton is a medical sociologist, and leads applied research in the Health Experiences Research Group (HERG). Improving patient experience is a global priority for health policy makers and care providers. How research on patient and staff experiences can make a difference in these areas is at the core of her research interests. Lisa has a portfolio of applied, mixed methods, social science research specialising primarily in women's health, in particular experiences of infertility, pregnancy, childbirth and neonatal care. She is also involved in several studies seeking to improve patient experiences in critical care.The role of digital technology in patient self-management and healthcare is another area of interest. Lisa leads qualitative work developing and evaluating complex interventions and is currently working on two clinical trials of self-monitoring of blood pressure. One is studying the impact of SMBP during pregnancy and a second the impact of SMBP after a stroke or TIA (see Hypertension). She also leads a programme of work as part of the Oxford BRC's Partnerships for Health Wealth and Innovation theme exploring research participation and patient and public involvement.

Mothers in Critical Care: learning from patients’ experiences & challenges to...

Intensive Care Society

Adrian Edwards - PRIME Social Care Consensus Meeting 20151005

angewatkins

White buffolo dental clinic 1

saskohc

Global trends in nursing

Roger Watson

Addressing the Psycho Social needs of the most vulnerable in North West Cameroon, this presentation summarizes the work of Integrated Development Foundation with Orphans, People living with HIV AIDS, those living in poverty, problems mothers face, health issues, those needing palliative care, microcredit program, Mme. Oussematou, Director of IDF gave this as a presentation at Old Barns United Church, Nova Scotia, Canada, May 2016.

Integrated Development Foundation, Bamenda, Cameroon Orphans and vulnerable ...

Lydia Sorflaten

Telemonitoring Opportunities for Community Nursing

Health Informatics New Zealand

NHS 5YFV Vanguards-Dr Chris Jones presentation

mckenln

Randall Children’s Hospital Presentation

Frances Quaempts-Miller

Nursing management of post covid 19 experiences

anjalatchi

Presentation by Coviu CEO Dr Silvia Pfeiffer at the Singapore "Women in Tech" conference, 19th September 2018. Dr Pfeiffer stipulates that with modern technology, healthcare systems of the future can be built that are cheaper to run and more scalable in the view of chronic disease, but require more patient responsibility, more patient education, and more patient data insights. http://womenintech.sg/agenda/

Building a Healthcare System from Scratch

Coviu Global Pty Ltd

Trends &challenges in nursing

Soumya Ranjan Parida

Palliative care in intensive care setting

Teik Beng Khoo

How Children’s Hospitals Are Shifting Toward Value and Population Health (All...

U.S. News Healthcare of Tomorrow

What does it mean for Service Delivery? - Alf Nicholson

Institute of Public Health in Ireland

Maternal and child health care

Sabeena Sasidharan

Similar to Phil hyde: Paeds Sim - Not for Dummies (20)

Bronwyn Avard - Getting Your Foot In The Door

Settings of pediatric illness care delivery

Midwifery Presentation by Triangle Midwives

Wekerle CIHR Team - Picturing Wellness: From Adversity to Resilience

Student Health Services Breakout Session

Mothers in Critical Care: learning from patients’ experiences & challenges to...

Adrian Edwards - PRIME Social Care Consensus Meeting 20151005

White buffolo dental clinic 1

Global trends in nursing

Integrated Development Foundation, Bamenda, Cameroon Orphans and vulnerable ...

Telemonitoring Opportunities for Community Nursing

NHS 5YFV Vanguards-Dr Chris Jones presentation

Randall Children’s Hospital Presentation

Nursing management of post covid 19 experiences

Building a Healthcare System from Scratch

Trends &challenges in nursing

Palliative care in intensive care setting

How Children’s Hospitals Are Shifting Toward Value and Population Health (All...

What does it mean for Service Delivery? - Alf Nicholson

Maternal and child health care

More from SMACC Conference

Precision Medicine in Acute Brain Injury

SMACC Conference

CORTICAL SPREADING DEPOLARISATION IN NEUROLOGICAL DISEASE – AN INTRODUCTION By Toby Jeffcote Cortical spreading depolarization (CSD) is a spreading loss of ion homeostasis, altered vascular response, change in synaptic architecture, and subsequent depression in electrical activity following an inciting neurological injury. It was first described by Leão in 1944, a disturbance in neuronal electrophysiology has since been demonstrated in a number of animal studies, and recently a few human studies that examine the occurrence of this depolarizing phenomenon in the setting of a variety of pathological states, including migraines, cerebrovascular accidents, epilepsy, intracranial hemorrhages, and traumatic brain injuries. The onset of CSD has been demonstrated experimentally following a disruption in the neuronal environment leading to glutamate-induced toxicity. This initial event leads to pathological changes in the activity of ion channels that maintain membrane potential. Recovery mechanisms such as sodium-potassium pumps that aim to restore homeostasis fail, leading to osmolar shifts of fluid, swelling of the neuron, and ultimately a measurable depression in cortical activity that spreads in the order of millimeters per minute. Equally important is the resulting change in vascular response. In healthy tissue, increased electrical activity is coupled with release of vasodilatory factors such as nitric oxide and arachidonic acid metabolites that increase local blood flow to meet increased energy expenditure. In damaged tissue, not only is the restorative vascular response lacking but a vasoconstrictive response is promoted and the ischemia that follows adds to the severity of the initial injury. Tissue threatened by this ischemic response is then at elevated risk for CSD propagation and falls into a vicious cycle of electrical and hemodynamic disturbance. Efforts have been made to halt this spreading cortical depression using N-methyl-D-aspartate receptor antagonists and other ion channel blockers to minimize the damaging effects of CSD that can persist long after the triggering insult.

CSD by Jeffcote Coda 22.pdf

SMACC Conference

Subdural Haemorrhage and MMA embolisation

SMACC Conference

Andy Neill - More neuroanatomy pearls for neurocritical care

SMACC Conference

Andrew Udy talks about Brain Tissue Oxygen Monitoring: It’s Not What You’ve Got It’s What You Do With It The BONANZA Trial Andrew Udy talks about the ongoing BONANZA Trial which is assessing whether an algorithm that incorporates both ICP and brain tissue oxygen (PbTO2) can improve outcomes after traumatic brain injury (TBI). Like with all monitoring, how the PbTO2 is interpreted and managed is critical and the devil is in the detail! More on BONANZA here More on BOOST3 here

The BONANZA Trial and PbTO2 Monitoring

SMACC Conference

Dilating the Dogma of Vasospasm

SMACC Conference

EVD Tips and Tricks

SMACC Conference

Part 2 of a debate over the classification of TBI. Andrew Udy then argues that this classification is fundamentally flawed. He discusses the issues with the Glasgow Coma Scale, and therefore the follow-on issues in TBI classification, including all the confounders to the GCS, the issues with timing of the score as well as GCS not taking baseline function or specifics subtypes of TBI into account. He makes teh argument that biomarkers may better categorise the diffuse entity we call TBI.

There is no such thing as mild, moderate and severe TBI - by Andrew Udy

SMACC Conference

Andrew Chow, Intensivist with a neurosurgical background, argues that the current categorisation system for traumatic brain injury (TBI) works, and makes sense! He tackles us through the history of this system, and why it’s important to differentiate different types of TBI. The arguments in favour of this categorisation include the consistency and benefits of a universal language, the implications for triage and management, and the fact that this system has been endorsed by all major organisations

TBI Debate - Mild, moderate and severe categories work

SMACC Conference

Dr Nick Little is an experienced Neurosurgeon who's looked after patients with traumatic brain injury for his whole career. Here he discusses the difficulties of prognostication following traumatic brain injury (TBI). He talks about the statistics of outcomes following mild, moderate and severe TBI and then goes on to tackle the harder topic of how we try to work out what an individual would want if they knew the spectrum of outcomes that they may face. The issues with the clinical examination findings we use to prognosticate are covered, as well as which imaging findings he finds most helpful. He also mentions the difficulties with current prognostic calculators.

TBI: when to stop and when to give time

SMACC Conference

Historically, when it came to brain injury, ketamine had a bad rap. Much of that dogma was dispelled in the last decade, and ketamine is now frequently used as an induction agent in acute brain injury, especially traumatic brain injury, due to it’s favorable effects on haemodynamics. However a new application of ketamine is now being explored - whether ketamine may be able to reduce secondary brain injury.

Ketamine in Brain Injury by Toby Jeffcote

SMACC Conference

20 million people around the world are living with a spinal cord injury (SCI). The medical issues they develop over the years differ to any other patient cohort. These complications include autonomic dysreflexia, management of pressure areas, specific infections, nuanced peri-operative care and highly specific issues such as baclofen pump management and syringomyelia Do look at the NeuroResus section on this and listen to Spinal Rehab Specialist Bonne Lee talk about this side of SCI care. Keywords SCI, spinal, spinal cord injury, autonomic dysreflexia, pressure areas, infection, peri-operative care, baclofen pump, syringomyelia, chronic SCI, spinal trauma, spinal rehab, incomplete SCI

Managing Complications of Chronic SCI by Bonne Lee

SMACC Conference

Tania is a neurologist and epileptologist with expertise in continuous EEG (cEEG) and status epilepticus (SE). This talk covers what a seizure is, what status is, including focal and generalised status epilepticus. So why do we do cEEGs for patients with suspected SE? To confirm the diagnosis To see if patient just post ictal or still seizing To establish that the clinical and electric seizures have stopped To see if burst suppression is achieved To exclude other differential diagnoses She makes a good argument for why cEEG is such an important tool in managing SE. In the questions after the talk, the issue of availability of cEEG in the Australian setting was discussed. Limited montage EEGs are discussed including their pros and cons.

EEG and Status Eplilepticus by Tania Farrar

SMACC Conference

Stuart Browne is a Neuro Rehab specialist from Sydney. These slides accompany a talk he gave at the Brian Symposium in 2023. He discusses what "severe disability" really means. Severe disability is more common than many realise - about 6% of the Australian population. Stuart discusses how health is more than simply physical recovery and how it is a multidimensional construct. He covers how permanent disability doesn't necessarily equate to a poor quality of life. He also discusses the long timespan of recovery, which is often much longer than appreciated. He specifically discusses "Locked-in Syndrome" and how the survivors have surprisingly positive self-reported health-related quality of life and well-being. Stuart also covers how severely disabled people face various forms of discrimination.

Browne Neuro symposium.pptx

SMACC Conference

Paediatric Stroke by Shree Basu

SMACC Conference

After spinal cord injury (SCI), there aren’t many interventions we have available that actually make a difference. Augmenting blood pressure to increase spinal cord perfusion pressure is an attractive concept that may improve neurological outcomes following SCI. We know that hypotension can make SCI worse. Clinical studies looking at blood pressure augmentation are mostly old, retrospective and flawed in various ways. Aiming for a MAP of > 85 for 5-7 days is recommended by guidelines but why this pressure and duration are good questions. Hypertensive therapy is relatively safe and easy to implement but not without risk. Tessa discusses the pros and cons, how this is managed practically and what the future may hold in this area.

Hypertensing Spinal Cord Injury - gold standard or wacky?

SMACC Conference

Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. He discusses the background to CPPopt, including intrcranial pressure (ICP), the Monroe Kelly hypothesis, neurovascular coupling, and cerebral autoregulation in health and following brain injury. He shows how intracranial pressure is affected by intracranial compliance and how this affects ICP waveforms. Cerebral perfusion pressure in relation to the Brain Trauma Foundation guidelines is covered including management of elevated ICP (EICP). The currently recommended tiered approach to managing cerebral perfusion pressure and EICP is mentioned citing recent guidelines. He uses a clinical case of a TBI to illustrate how the CPPopt can be ascertained and used to guide therapy, including the easy to perform “MAP Challenge”. Mark also describes the Pressure Reactivity Index (PRx) and how it can be used as a target for therapy. Finally, he covers the exciting results of the preliminary COGiTATE pilot study.

Optimal Cerebral Perfusion Pressure

SMACC Conference

The Power of Words - Death and Language.ppt

SMACC Conference

Appropriate use of antimicrobials is primarily a patient safety issue, and is the key aim of an effective antimicrobial stewardship program. We discuss the challenges in the management of a patient with sepsis, and how decision-making is usually done in the absence of effective diagnostics. Time dependent protocols and the knowledge that undertreatment of a patient with sepsis will lead to poor outcomes will lead to prescribing that may be driven by fear. Antimicrobial resistance is associated with over-use of antimicrobials but is usually not the immediate concern. Antimicrobial stewardship programs should work closely with sepsis teams to ensure that sepsis pathways are implemented across the whole hospital, and that key principles of judicious use are embedded within the clinical pathway.

Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin

SMACC Conference

Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources. However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task. Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome. Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models. There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases. We end with three brief vignettes which highlight the fraught nature of long term outcome prediction.

Brain injury outcomes and predictors

SMACC Conference

More from SMACC Conference (20)

Precision Medicine in Acute Brain Injury

CSD by Jeffcote Coda 22.pdf

Subdural Haemorrhage and MMA embolisation

Andy Neill - More neuroanatomy pearls for neurocritical care

The BONANZA Trial and PbTO2 Monitoring

Dilating the Dogma of Vasospasm

EVD Tips and Tricks

There is no such thing as mild, moderate and severe TBI - by Andrew Udy

TBI Debate - Mild, moderate and severe categories work

TBI: when to stop and when to give time

Ketamine in Brain Injury by Toby Jeffcote

Managing Complications of Chronic SCI by Bonne Lee

EEG and Status Eplilepticus by Tania Farrar

Browne Neuro symposium.pptx

Paediatric Stroke by Shree Basu

Hypertensing Spinal Cord Injury - gold standard or wacky?

Optimal Cerebral Perfusion Pressure

The Power of Words - Death and Language.ppt

Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin

Brain injury outcomes and predictors

Recently uploaded

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

Dipal Arora

Model Call Girl Services in Delhi reach out to us at 🔝 9953056974 🔝✔️✔️ Our agency presents a selection of young, charming call girls available for bookings at Oyo Hotels. Experience high-class escort services at pocket-friendly rates, with our female escorts exuding both beauty and a delightful personality, ready to meet your desires. Whether it's Housewives, College girls, Russian girls, Muslim girls, or any other preference, we offer a diverse range of options to cater to your tastes. We provide both in-call and out-call services for your convenience. Our in-call location in Delhi ensures cleanliness, hygiene, and 100% safety, while our out-call services offer doorstep delivery for added ease. We value your time and money, hence we kindly request pic collectors, time-passers, and bargain hunters to refrain from contacting us. Our services feature various packages at competitive rates: One shot: ₹2000/in-call, ₹5000/out-call Two shots with one girl: ₹3500/in-call, ₹6000/out-call Body to body massage with sex: ₹3000/in-call Full night for one person: ₹7000/in-call, ₹10000/out-call Full night for more than 1 person: Contact us at 🔝 9953056974 🔝. for details Operating 24/7, we serve various locations in Delhi, including Green Park, Lajpat Nagar, Saket, and Hauz Khas near metro stations. For premium call girl services in Delhi 🔝 9953056974 🔝. Thank you for considering us!

Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7

9953056974 Low Rate Call Girls In Saket, Delhi NCR

Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Girl UKHBET Escorts Service Available ✔ All Day And Night Booking Details Are here 05-May-2024( Mj) 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! 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

Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...

parulsinha

Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine Sex Service At Affordable Rate Booking Contact Details Whatsapp Chat :+91- 9332606886 These professional and Call girls in Bangalore can satisfy your every desire - be it sensual massage or an erotic shower, they are always more than willing to meet them. Furthermore, they pay close attention to body language cues to ensure you enjoy every minute spent in their company - both in-call and outcall services are offered. Is an excellent choice for anyone seeking an exciting and thrilling night of fun and excitement The Oberoi, Bengaluru Taj West End The Leela Palace Bengaluru JW Marriott Hotel Bengaluru The Ritz-Carlton, Bangalore Sheraton Grand Bangalore Hotel at Brigade Gateway Conrad Bengaluru ITC Gardenia, Bengaluru Renaissance Bengaluru Race Course Hotel The Lalit Ashok Bangalore 30 apr 24 (LK)

Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...

narwatsonia7

Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl In 5 Star Hotel Service Available Booking Contact Details WhatsApp Chat: +91-8617370543 Guwahati Escort Service includes providing maximum physical satisfaction to their clients as well as engaging conversation that keeps your time enjoyable and entertaining. Plus they look fabulously elegant; making an impressionable Independent Escorts Guwahati understands the value of confidentiality and discretion - they will go the extra mile to meet your needs. Simply contact them via text messaging or through their online profiles; they'd be more than delighted to accommodate any request or arrange a romantic date or fun-filled night together. We provide - Flexibility Choices and options Lists of many beauty fantasies Turn your dream into reality Perfect companionship Cheap and convenient In-call and Out-call services And many more.

Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...

Dipal Arora

Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426 Call Girls in Call\\Us))),(Delhi) We are Provide best Genuine Normal, High class call girls. escort service at affordable price. We Are One Of The Oldest Escorts and Call girls Agencies in Delhi You Will Find That Our Female Escorts Are Full Of Fun, Sexy And They Would Love Enjoy Your Company. We Have A Fantastic Selection Of Callo Girls Ladies Available For In-Calls As Well As Out-Calls. Our Escorts Are Not Only Beautiful But All Have Great Personalities Making Them The Perfect Companion For Any Occasion. In-Call: — You Can Come at Our Location in Delhi Which Is Very Clean Hygienic 100% safe Accommodation. Out-Call: — You have To come and Pick Girl From My Place We are Also Provide Door Step Services in Delhi , Gurgaon, Noida. Hygienic: — Full Ac Neat And Clean Rooms Available In Hotel 24 * 7 Hour In Delhi NCR, We Are Providing : — all Types of girls Indian, North East , Foreigner , Airhostess, many More. Service type — In-call Shot 1500, 2,000– In — Call Night /Out-call Night 6,000, to 7,000 — Hi-Fi Rates Shot — 2,000 to 4,000 Full Night 8,000 to 10,000 More Details, Call//WhatsApp, 97111 🔝 ⇛47426

Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426

jennyeacort

Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine Escort Service & Hotel Service Available Call Mr Chirag Ji +91-7427069034 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls, Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in Chennai 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 Chennai C010524HD 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 — 7427069034 !! Thank you for Visiting.

Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...

hotbabesbook

Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High profile Girls VIP Call Girl Pune As Enjoy Never Ending Pune VIP Call Girls is highly qualified professionals. #S10 They will offer only top quality services and never try to scam or drain you of money; in fact, they strive to give complete satisfaction so that each cent spent was worth its worth. Furthermore, these professionals pride themselves in keeping customer details confidential; any information gleaned will never be shared with any third party. Two shots with one girl: ₹4500/in-call, ₹7500/out-call Body to body massage with : ₹5500/in-call Full night for one person: ₹7000/in-call, ₹12000/out-call •𝐂𝐨𝐥𝐥𝐞𝐠𝐞 𝐆𝐢𝐫𝐥𝐬 •𝐇𝐨𝐮𝐬𝐞𝐰𝐢𝐯𝐞𝐬 •𝐇𝐢𝐠𝐡 𝐏𝐫𝐨𝐟𝐢𝐥𝐞 𝐆𝐢𝐫𝐥𝐬 •𝐑𝐚𝐦𝐩 𝐌𝐨𝐝𝐞𝐥𝐬 •𝐅𝐨𝐫𝐞𝐢𝐠𝐧𝐞𝐫 𝐆𝐢𝐫𝐥𝐬 𝐎𝐮𝐫 𝐞𝐬𝐜𝐨𝐫𝐭 𝐬𝐞𝐫𝐯𝐢𝐜𝐞𝐬 •𝐇𝐉 (𝐇𝐚𝐧𝐝 𝐉𝐨𝐛) •𝐁𝐉 (𝐁𝐥𝐨𝐰𝐣𝐨𝐛) # Completion # (Oral To Completion) # Special Massage # O-Level (Oral ) # Oral With A Noncondom) # COB (Come On Body) # Extraball (Have Many Times) # All Meetings 100%Safe Call Payal:-- 9352988975

Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...

chetankumar9855

Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Gwalior Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Gwalior 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 Gwalior 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 Gwalior Just Call 8617370543 Top Class Call Girl Service Available

Dipal Arora

☑️░ 9630942363 ░ CALL GIRLS ░ VIP ░ ESCORT ░ SERVICES ░ AGENCY ░ 9630942363 THE GENUINE ESCORT AGENCY VIP LUXURY CALL GIRLS HIGH CLASS MODELS CALL GIRLS GENUINE ESCORT BOOK BOOK APPOINTMENT - 9630942363 THE GENUINE ESCORT AGENCY BEST VIP CALL GIRLS & ESCORTS SERVICE 9630942363 VIP CALL GIRLS ALL TYPE WOMEN AVAILABLE INCALL & OUTCALL BOTH AVAILABLE BOOK NOW 9630942363 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 9630942363 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 FOR BOOKING 9630942363

Call Girls Vasai Virar Just Call 9630942363 Top Class Call Girl Service Avail...

GENUINE ESCORT AGENCY

Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy Bhabi Ready For Sex At Your Doorstep Booking Contact Details Whatsapp Chat :+91-6297143586 These professional and Call girls in Bangalore can satisfy your every desire - be it sensual massage or an erotic shower, they are always more than willing to meet them. Furthermore, they pay close attention to body language cues to ensure you enjoy every minute spent in their company - both in-call and outcall services are offered. Is an excellent choice for anyone seeking an exciting and thrilling night of fun and excitement The Oberoi, Bengaluru Taj West End The Leela Palace Bengaluru JW Marriott Hotel Bengaluru The Ritz-Carlton, Bangalore Sheraton Grand Bangalore Hotel at Brigade Gateway Conrad Bengaluru ITC Gardenia, Bengaluru Renaissance Bengaluru Race Course Hotel The Lalit Ashok Bangalore 1-may-24

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

vidya singh

💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lonely Housewife In Top Rated Hotel WhatsApp Chat : +91-9257276172 Get More Information About Jaipur Escorts Service Jaipur 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.

💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...

khalifaescort01

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

Dipal Arora

Call Girls Raipur Just Call 9630942363 Top Class Call Girl Service Available

GENUINE ESCORT AGENCY

Top Rated Bangalore Call Girls Mg Road ⟟ ⟟ Call Me For Genuine Sex Service At Affordable Rate Booking Contact Details Whatsapp Chat :+91- These professional and Call girls in Bangalore can satisfy your every desire - be it sensual massage or an erotic shower, they are always more than willing to meet them. Furthermore, they pay close attention to body language cues to ensure you enjoy every minute spent in their company - both in-call and outcall services are offered. Is an excellent choice for anyone seeking an exciting and thrilling night of fun and excitement The Oberoi, Bengaluru Taj West End The Leela Palace Bengaluru JW Marriott Hotel Bengaluru The Ritz-Carlton, Bangalore Sheraton Grand Bangalore Hotel at Brigade Gateway Conrad Bengaluru ITC Gardenia, Bengaluru Renaissance Bengaluru Race Course Hotel The Lalit Ashok Bangalore

Most Beautiful Call Girl in Bangalore Contact on Whatsapp

Inaaya Sharma

Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For Genuine Sex Service At Affordable Rate Booking Contact Details Whatsapp Chat :+91- 9332606886 These professional and Call girls in Bangalore can satisfy your every desire - be it sensual massage or an erotic shower, they are always more than willing to meet them. Furthermore, they pay close attention to body language cues to ensure you enjoy every minute spent in their company - both in-call and outcall services are offered. Is an excellent choice for anyone seeking an exciting and thrilling night of fun and excitement The Oberoi, Bengaluru Taj West End The Leela Palace Bengaluru JW Marriott Hotel Bengaluru The Ritz-Carlton, Bangalore Sheraton Grand Bangalore Hotel at Brigade Gateway Conrad Bengaluru ITC Gardenia, Bengaluru Renaissance Bengaluru Race Course Hotel The Lalit Ashok Bangalore 30 apr 24 (LK)

Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...

narwatsonia7

All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP Call Girl At Their Home & Hotels Booking Contact Details WhatsApp Chat: +91-9820252231 Mumbai Escort Service includes providing maximum physical satisfaction to their clients as well as engaging conversation that keeps your time enjoyable and entertaining. Plus they look fabulously elegant; making an impressionable. Independent Escorts Mumbai understands the value of confidentiality and discretion - they will go the extra mile to meet your needs. Simply contact them via text messaging or through their online profiles; they'd be more than delighted to accommodate any request or arrange a romantic date or fun-filled night together. We provide - Flexibility Choices and options Lists of many beauty fantasies Turn your dream into reality Perfect companionship Cheap and convenient In-call and Out-call services And many more. 01-05-24 (Smt)

All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...

Arohi Goyal

Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Shimla Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Shimla 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 Shimla 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 Shimla Just Call 8617370543 Top Class Call Girl Service Available

Dipal Arora

Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 hours available Call Mr Chirag Ji +91-7427069034 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls, Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in Chennai 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 Chennai C010524HD 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 — 7427069034 !! Thank you for Visiting.

Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...

hotbabesbook

9630942363 THE GENUINE ESCORT AGENCY VIP LUXURY CALL GIRLS HIGH CLASS MODELS CALL GIRLS GENUINE ESCORT BOOK BOOK APPOINTMENT - 9630942363 THE GENUINE ESCORT AGENCY BEST VIP CALL GIRLS & ESCORTS SERVICE 9630942363 VIP CALL GIRLS ALL TYPE WOMEN AVAILABLE INCALL & OUTCALL BOTH AVAILABLE BOOK NOW 9630942363 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 9630942363 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 FOR BOOKING 9630942363

Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available

GENUINE ESCORT AGENCY

Recently uploaded (20)