“Mohammad Ali suddenly collapsed after

40 minutes into the race”

 LI 1: STRESS
● Upset stomach.
-effects on body (aqilah)
Affect how quickly food moves through the body. Can induce muscle spasms in the bowel which can be painful.
Weak intestinal barrier allow gut bacteria to enter the body.
● Chest pain.
Heart pumps faster. Stress hormones cause blood vessels to constrict to divert more oxygen. This will raises blood
pressure.
● Tense muscles.
Muscles tense up to protect themselves from injury when you’re stressed. Constantly under stress, muscles may not
get the chance to relax which cause headaches, back and shoulder pain, and body aches.
● Nervousness and shaking.
Adrenaline and cortisol revive up heartbeat & send blood rushing to the areas that need it most in an emergency.
● Cold or sweaty hands and feet.
● Weak immune system.
Reduce body’s response to foreign invaders. More susceptible to viral illnesses. Increase the time it takes you to
recover from an illness or injury.
 LI 2: SIGNIFICANCE COPING
WITH STRESS (aqilah)
❖ Ensure the effectiveness of body system.

❖ Improves sleep and reduces irritability, anxiety and depression.

❖ Increase the absorption of nutrients to the blood - strengthen the immune system.

❖ Avoid irregular menstrual cycle, painful period and changes in the length of cycle.

❖ Increase sexual desire - increase testosterone production, percentage of sperm

motility (ability to swim) and percentage of sperm of normal morphology (size and
shape).

❖ Focusing on the good, working toward positive goals, can become more impervious
to life’s little problems.
LI 3: PATHOPHYSIOLOGY OF
VASOVAGAL SYNCOPE
Vasovagal syncope
-most common
-harmless
-occurs-faint because your body overreacts to certain triggers
-result in heart rate and blood pressure to drop suddenly
-triggers include:
Standing for long periods of time, dehydration, the sight of blood,
extreme emotional distress, getting overheated, intense physical activity
Pathophysiology
 Prevention OF SYNCOPE
-->Know the warning signs of fainting

•If possible, lie down. This can help prevent a fainting episode, as it lets blood
get to the brain

•Don't let yourself get dehydrated

•Keep blood circulating

•Avoid overheated, cramped, or stuffy environments, whenever possible.

LI 4: VAGUS NERVE
STIMULATION
 Vagus Nerve (Cranial Nerve X)
Longest cranial nerve & has widest distribution in body

Contain motor and sensory fibres from bottom of brain to neck, thorax,
esophagus , abdomen and GIT
 Vagus Nerve (Cranial Nerve X)
Sensory function Motor function
Somatic sensation information Stimulate muscle

● Eg: skin behind the ear ● Pharynx, larynx

Visceral sensation information Stimulate muscle in heart

● Eg: esophagus, lungs, trachea ● Lower the heart rate

Small role in sensation of taste near root of Stimulate involuntary contraction

tongue
● Esophagus, stomach, intestine
 Vagus nerve problems
Nerve damages
Nerve is so long and involve many areas. Thus
wide range of symptoms could be identified ;
● Unusual heart rate
● Abnormal blood pressure
● Difficult to speak
● Vomiting
● Abdominal bloating or pain
● Loss gag reflex ( testing )
Overreacts of vagus nerve
● Exposure to extreme temperature or stand
for a long time.
● Emotional Stress
● Vagus nerve stimulates certain muscles in
the heart ——-> control heart rate.
● When it overreacts, it can cause a sudden
drop in heart rate and blood pressure,
resulting in fainting.
● This is known as vasovagal syncope
● Extreme fear: loss of bladder control .
 LI 5: DEHYDRATION
“ More than 5% reduction of total water, especially
Extracellular Volume(ECV)”
 TYPES OF DEHYDRATION

HYPERTONIC ISOTONIC HYPOTONIC

- > H20 loss - > Loss of salt

- Causes - Causes
HYPERNATREMIA - Proportional loss HYPONATREMIA
- Serum of H20 and salt in - Serum
Na > 147 mEq/L ECV Na < 135 mEq/L
- Water flow from - Water flow from
ICF to ECF ECF to ICF
 HYPERTONIC HYPOTONIC

R A T I ON
DEHYD ES
TYP
ISOTONIC
 DIFFERENCES BETWEEN HYPERTONIC, ISOTONIC, HYPOTONIC DEHYDRATION

HYPERTONIC ISOTONIC HYPOTONIC

( HYPERNATREMIC) (ISONATREMIC) (HYPONATREMIC)

Loses H20 > Na H20 = Na H20 < Na

Plasma Osmalality Increase Normal Decrease

Serum Na Increase Normal Decrease

ECV Decrease Decrease Decrease +++

ICV Decrease +++ Maintained Increase

 STAGES
●Mild Dehydration– you lose 3% to 5% of your body weight
- occur because of normal sweating on a hot day or excess urination
- can cause one to feel a bit thirsty and dry-mouthed
●Moderate Dehydration – you lose 6% to 9% of your body weight
- result in abnormalities in the body’s potassium and sodium levels, which could affect the
rhythm of our heartbeat, as the heart needs to work more to pump blood and oxygen throughout
your body
- symptoms of moderate dehydration include:
Dry mouth, lips and nose
Extreme thirst
Decreased urine output
Deep, rapid breathing
Headaches
Dry skin
Dizziness and feeling light-headed
 STAGES
Severe Dehydration– you lose 10% or more of your body weight
- serious and requires medical intervention to prevent damage to your kidneys or liver
- can also cause kidney stones to form and can damage muscle and create cholesterol
problems.
Some of the symptoms:
- Severe diarrhoea
- Vomiting or a fever
- Feeling disoriented
- Sunken, dry eyes
- A weak pulse
- Fits (seizures)
- Low blood pressure (hypotension)
- A low level of consciousness

Severe dehydration normally requires hospitalisation and a drip to restore fluids. If not
attended to immediately it can lead to various complications, including death.
CAUSES

- Excessive sweat production

- Vomitting
- Diarrhea
- Increase volume of urine
- Inability to get enough water supply
- Severe burn
EFFECTS
Short Term Effects:

- Dizzy
- Fainting
- Dry skin
- Not peeing or having dark yellow pee
- Sleepiness (lack of energy)

Long Term Effects :

- Kidney failure
- Coma
- Shock
- Heat stroke
- Electrolyte abnormalities
LI 6: BODY HOMEOSTASIS
BODY TEMPERATURE
Body temperature homeostasis

When body temperature drops below normal, thermoregulatory centre in hypothalamus detects the
reduction in temperature.

Nervous system send signals to skin blood vessels to vasoconstrict and reduce heat loss. Sweat gland do not
secrete fluid.

If body temperature continues to drop, nervous system signals muscles to contract involuntarily (shivering),
generates heat which warms the body.

Heat is retained and body temperature returns to normal.

When temperature rises above normal, thermoregulatory centre in hypothalamus detects the increase in
body temperature.

Nervous system sends signals to skin blood vessels to vasodilate capillaries filled with warm blood and heat
radiates from skin surface. Sweat glands activated, increasing evaporative cooling.

Body temperature decreases to normal.

BODY FLUID LEVELS
 Water balance regulation and homeostasis
An osmoreceptor is a sensory receptor that detects changes in osmotic pressure and is primarily found in the
hypothalamus.When the osmoreceptors detect high plasma osmolarity (often a sign of a low blood volume), they send
signals to the hypothalamus, which creates the biological sensation of thirst. Osmoreceptors also stimulate
vasopressin (ADH) secretion, which starts the events that will reduce plasma osmolarity to normal levels.

The body’s homeostatic control mechanisms maintain a constant internal environment to ensure that a balance
between fluid gain and fluid loss is maintained. The hormones ADH (anti-diuretic hormone, also known as
vasopressin) and aldosterone, a hormone created by the renin–angiotensin system, play a major role in this balance.

ADH Feedback

- blood volume becomes too low, plasma osmolarity will increase due to a higher concentration of solutes per volume
of water.

-Osmoreceptors in the hypothalamus detect the increased plasma osmolarity and stimulate the posterior pituitary
gland to secrete ADH.
-ADH causes the walls of the distal convoluted tubule and collecting duct to become permeable to water—this
drastically increases the amount of water that is reabsorbed during tubular reabsorption. (ADH also causes the
epithelial cells that line the renal collecting tubules to move water channel proteins, called aquaporins, from the
interior of the cells to the apical surface, where these proteins are inserted into the cell membrane)
Aldosterone Feedback (RAAS)

- low blood volume activates the juxtaglomerular apparatus (JGA) in a variety of ways to make it
secrete renin.

-Renin cleaves angiotensin I from the liver -produced angiotensinogen. Angiotensin converting
enzyme (ACE) in the lungs converts angiotensin I into angiotensin II.

-Angiotensin II has a variety of effects (such as increasing thirst) but it also causes release of
aldosterone from the adrenal cortex.

-Aldosterone has a number of effects that are involved in the regulation of water output. It acts on
mineral corticoid receptors in the epithelial cells of the distal convoluted tubule and collecting duct to
increase their expression of Na+/K+ ATPase pumps and to activate those pumps.

-This causes greatly increased reabsorption of sodium and water (which follows sodium osmotically
by cotransport).
SWEAT PRODUCTION IN MAINTAINING HOMEOSTASIS
Body Temperature Rises

Sympathethic Nervous System

stimulates

Eccrine Sweat Glands

release Evaporation
- cooling
SWEA
effect
T

Back to normal body temperature

 “ EXCESSIVE SWEATING CAN CAUSE
DEHYDRATION”
Sweating can dehydrate you. Dehydration decreases your blood
volume, which can halt blood flow to your skin and cause you to become
overheated. Consequently, you will experience impaired muscular
strength and endurance, decreased alertness and increased risk of
injury.
LI 7: PATHOPHYSIOLOGY OF
HEAT STROKE
What is heat stroke?
● A condition where the body temperature may be dangerously
elevated due to excessive exposure to heat, with dry skin, vertigo,
headache, thirst, nausea, and muscular cramps.

● Heat stroke is defined as hyperthermia exceeding 40°C (104°F),

diaphoresis, and an altered sensorium, which may occur suddenly
during extreme physical exertion in a hot environment.
Non-exertional heat stroke is
associated with high
environmental heat (heat wave)
and humidity with inadequate
cooling.
Classic heat stroke typically has
a slow onset, often developing
over days. It generally affects the
elderly ,people who live
sedentary and the chronically ill,
who may present with anorexia,
nausea, vomiting, headache,
dizziness, confusion, and
hypotension.
Exertional heat stroke
usually affects young
people in good health who
are exercising in a hot,
humid environment, often
Types of Heat with clothing or equipment
Stroke that restricts cooling. It is
rapid in onset, where
dizziness, nausea and
vomiting are common.
Profuse sweating is a
typical finding on
examination.
Pathophysiology pathway of Heat Stroke
The body gains heat from Due to the
This process extremely
metabolism and from the
(thermoregulation) relies elevated body
hot environment, and this
primarily on cutaneous temperature,
heat must be dissipated to
vasodilatation and this causes the
maintain a normal
evaporation of sweat. temperature-
temperature of 37° C.
regulating
mechanism to
be overwhelmed
When the core and eventually
temperature exceeds shut down.
Series if symptoms 40° C, elevated
If the Hence, the core
begin to appear; temperature becomes
condition is temperature
headache, destructive to tissue
prolonged, rises even more.
dizziness,nausea,
it can lead cells, especially to the
vomitting and
to death. brain (cytokines and
unconsciousness.
heat shock protein-
HSP-70).
 Treatment
1. Remove clothing.
2. Maintain a spray of cool water all over the
body/continuously sponge the body.
3. Blow air over the body using a fan.
4. Minimize dehydration and use intravenous fluid for
rehydration.
L8: SERVICE OF AMBULANCE
AMBULANCE SERVICE TEAM
The person that is involved in the ambulance first aid treatments are :

1. The ambulance’s driver

- They do have a specific test and course (JPJ - special license) to make sure they are
well trained to drive the ambulance and capable to give a few simple first aids
treatments to the patients.
2. Assistance medical officer (Malaysia) / paramedic (worldwide)
- The person that will response to the emergency cases, stabilize the patients,
reduce the probability for the injury to get severe and make a decisions on where
to send the patient depends on patient’s condition.
3. Medical officer
- Not often because it depends on the staff available and severity of the cases.
 TREATMENT
The treatment that is available is totally depends on few factors such as the
staff available and the types of ambulances used. The common treatments are
:

1. Electrocardiogram
2. Advance airway procedure
3. Intravenous initiation
4. Oxygen therapy
 Types of ambulance
There are 3 types of ambulance available in Malaysia healthcare
institution:

1. Type C - found in the rural health centers with basic equipments

- Stretcher trolley, cervic collar, oxygen tank and mask, first aid kit
and medicines.
2. Type B - found in the district hospitals with additional equipments
- Oxygen resuscitator, portable suction machines, immobilization
kit and vital sign transport monitor.
3. Type A - found in the larger cities with more advanced
equipments
- Paramedic suite helmets, safety boat, dead body and
management kit.
CPR; CARDIOPULMONARY RESUSCITATION
1. Check either he/she is conscious or not by shouting and shake his/her shoulder.
2. Open the airway check for breathing by using both of your hand and sense (listen,
look, feel) must be not more than 10 sec.
3. Check for pulse - wrist for confirmation
- PULSE FOUND - give 1 breath every - 5-6 sec until breathing resumed normally
- NO PULSE - begin chest compression
4. Ask anyone to make an emergency call 999
5. Interlock your fingers, put your hands on the right position and straightened your
arms.
6. Begin your chest compression
7. Give 2 rescue breath for every 30 compressions to provide some oxygen (if
comfortable)
8. Do not stop! until the health professional takes over or the person begin to
breathing normally - u can swap with anyone nearby