INTRODUCTION
The current heat wave condition triggered by the El Nino Phenomenon , name given to above-normal temperatures in the Pacific Ocean that have the potential to cause devastating conditions around the world especially for the tropical country , and Malaysian being in the equatorial climate poses significant risk of heat injuries for all individuals especially for those participating in strenuousphysical activities as in endurance sports, military training and working outdoors (eg. construction workers).
PATHOPHYSIOLOGY
The classical models of heat stroke attributed the pathogenesis of heat stroke to the direct cytotoxic effect of hyperthermia coupled with circulatory shock resulting from excessive dehydration. Hyperthermia results in internal organ tissue temperatures rising above critical levels causing damage to the cell membranes and energy systems. Dehydration and salt depletion impairs thermoregulation and the compromise in blood circulation reduces blood flow to the major organs, causing them to fail
eventually. However, these factors cannot explain fully the observation of systemic coagulation, massive haemorrhages and other sepsis-like clinical symptoms observed in heat stroke
patients.
