Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Acute Respiratory Distress Syndrome


Related Terms

  • Adult Respiratory Distress Syndrome
  • Congestive Atelectasis
  • Pump Lung
  • Shock Lung
  • Stiff Lung

Differential Diagnosis

Specialists

  • Critical Care Internist
  • Infectious Disease Internist
  • Pulmonologist

Comorbid Conditions

Factors Influencing Duration

Factors that influence the length of disability include the duration of disease prior to treatment, underlying cause of condition, type of treatment, response to treatment, and possible complications.

Medical Codes

ICD-9-CM:
518.82 - Pulmonary Insufficiency, Other, Not Elsewhere Classified; Acute Respiratory Distress; Acute Respiratory Insufficiency; Adult Respiratory Distress Syndrome NEC

Overview

Acute respiratory distress syndrome (ARDS) is the rapid onset of progressive respiratory failure caused by severe swelling in the lungs (pulmonary interstitial and alveolar edema) and diffuse alveolar damage, which usually develops within 2 to 4 days after an initiating trauma or illness. It is usually associated with other severe illnesses and the malfunction of other organs. It may also result from receiving high percentages of oxygen delivered over extended periods of time (oxygen toxicity).

The condition is characterized by extensive lung inflammation and the abnormal accumulation of fluid in the lung tissue that is not associated with heart problems (noncardiogenic pulmonary edema), fat embolization, or inadequate oxygenation of the blood (hypoxemia).

ARDS may be precipitated by a variety of acute processes that either directly or indirectly injure the lung, such as trauma, an infection in the blood (sepsis), bacterial or viral pneumonia, a drug overdose, aspiration of gastric contents, acute hemorrhagic pancreatitis, inhalation of smoke or other toxic fumes, nearly drowning, shock, and it may be associated with extensive surgery and certain blood abnormalities.

Although mortality from ARDS is high, it has improved in recent years. The rate varies based on the individual's age and health and the severity of the condition causing the distress. It is a common problem in hospital intensive care units (Schraufnagel).

Incidence and Prevalence: Approximately 75% of those with acute lung disease will develop the more severe form of ARDS. An estimated 190,600 people per year develop acute lung injury, and 74,500 die of, or with, the disease in the US (Schraufnagel).

Source: Medical Disability Advisor



Causation and Known Risk Factors

ARDS can occur in people with or without a previous lung disease, usually during treatment for another serious illness or a major injury. A serious injury that results in a large amount of blood loss also puts people at higher risk of ARDS. Sepsis is the most common condition related to ARDS (Schraufnagel).

Source: Medical Disability Advisor



Diagnosis

History: Individuals with ARDS complain of difficulty breathing (dyspnea). ARDS can follow a wide variety of pulmonary or nonpulmonary insults. Other symptoms are usually related to the predisposing condition.

Physical exam: The exam findings are not disease-specific for ARDS and include mottled or bluish complexion (cyanosis) due to hypoxemia, moist skin, labored breathing, excessively rapid shallow breathing (tachypnea), excessively rapid heartbeat (tachycardia), agitation, and lethargy followed by clouding of consciousness (obtundation). Listening with a stethoscope (auscultation) may detect crackles, rhonchi, or wheezes. Low blood pressure is usually found.

Tests: Lab studies will include a complete blood count (CBC), sputum cultures, and arterial blood gases (ABGs) that reveal hypoxemia. Chest x-rays will be taken to check for the presence of infiltrates in both (bilateral) lungs. A pulmonary artery catheter may be placed. The classic series of tests to confirm a diagnosis of ARDS is a pulmonary arterial wedge pressure (PAWP), an alveolar oxygen pressure (PaO2), and a fraction of inspired oxygen (FiO2).

Source: Medical Disability Advisor



Treatment

Oxygenation must be maintained while the underlying cause of the lung injury is identified and treated. Passing a tube (intubation) through the nose or mouth (endotracheal tube, or ETT) into the trachea is often required. Ventilation (respirator) or supportive breathing (positive end expiratory pressure, or PEEP) is usually necessary to support the damaged respiratory system. Severe cases may be treated with cardiopulmonary bypass. Medications (antibiotics, antivirals, or antifungals) may be needed to treat infections. In addition, pain relievers and muscle relaxants may help reduce movement, thereby decreasing the body's demand for oxygen. Management includes prevention of nutritional depletion, oxygen toxicity, superinfection, and renal failure.

Source: Medical Disability Advisor



Prognosis

ARDS is a severe, life-threatening condition requiring intensive care unit hospitalization. The death rate for ARDS is approximately 40% (Schraufnagel). Nonsurvivors usually succumb to sepsis or multiple organ system failure. The death rate is proportionate to the number of failed organ systems. With four or more (including the lung), mortality is near 100%. Individuals who survive usually recover normal lung function with minimal, if any, persistent pulmonary symptoms. Those who survive severe cases may suffer permanent pulmonary fibrosis, restrictive lung disease, or cognitive defects such as memory loss, which is thought to result from hypoxia.

Source: Medical Disability Advisor



Rehabilitation

If an individual recovers form a long illness, he or she may require physical therapy to regain muscle conditioning.

Source: Medical Disability Advisor



Complications

Possible complications of this condition include tension pneumothorax, pneumonia precipitated by mechanical ventilation (ventilator-assisted pneumonia), secondary bacterial superinfection of the lungs, and multiple organ system failure (especially renal failure). Cardiovascular or renal problems may affect the individual's ability to recover and may further lengthen disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

It is important to avoid smoke, fumes, dust, and any other irritant that could be inhaled while recovering from ARDS. Proper ventilation, masks, or respirators may be necessary. Inhaling extremely hot or extremely cold air can also trigger recurrence of symptoms. If the individual suffers from dyspnea, a temporary or permanent reduction in the job's physical demands may be needed.

Risk: Jobs that require exposure to heavy fumes, dusts and respiratory irritants are best avoided if possible, although a paper mask may be sufficient protection in most cases. More advanced mask systems as per OSHA guidelines should also be used in certain industries.

Capacity: This is measurable with pulmonary function testing (PFT), often with metabolic stress echocardiogram (ECHO) testing to confirm oxygenation.

Tolerance: Tolerance may be improved by ensuring medication compliance if prescribed, excluding concurrent conditions such as anemia, and possibly offering rapid testing and physician evaluation should the individual have a recurrence of symptoms.

Source: Medical Disability Advisor



Maximum Medical Improvement

360 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have difficulty breathing (dyspnea)?
  • Although not disease-specific for ARDS, does individual have mottled or bluish complexion (cyanosis) due to decreased oxygen levels in the circulating blood, moist skin, labored breathing, excessively rapid shallow breathing (tachypnea), excessively rapid heartbeat (tachycardia), agitation, and lethargy followed by clouding of consciousness (obtundation)?
  • Were sputum culture and arterial blood gases (ABGs) done? Was chest x-ray done? Were a pulmonary arterial wedge pressure (PAWP), an alveolar oxygen pressure (PaO2), and a fraction of inspired oxygen (FiO2) performed?
  • Was diagnosis of ARDS confirmed?
  • Were conditions with similar symptoms ruled out? Are sequelae (such as residual pulmonary impairment or cognitive defects) present?

Regarding treatment:

  • Has underlying cause of lung injury been identified? Is it responding to treatment?
  • Were medications (antibiotics, antivirals, antifungals, corticosteroids) successful in resolving infection and reducing inflammation?
  • Were culture and sensitivity done to identify the causative organism and determine the most effective medication?
  • Were antibiotic-resistant organisms ruled out?
  • If mechanical ventilation (respirator) or supportive breathing (positive end expiratory pressure, or PEEP) was necessary to support the damaged respiratory system, did complications occur when it was time to wean individual off the machine?

Regarding prognosis:

  • Has normal lung function returned? Does individual have any residual pulmonary impairment?
  • If condition was severe, was there permanent pulmonary fibrosis or restrictive lung disease? What impact does this have on individual's ability to function?
  • Did complications develop, such as tension pneumothorax, secondary bacterial superinfection of the lungs, or multiple organ system failure?

Source: Medical Disability Advisor



References

Cited

"Acute Respiratory Distress Syndrome." MedlinePlus. 3 Mar. 2012. National Library of Medicine. 6 Apr. 2014 <http://www.nlm.nih.gov/medlineplus/ency/article/000103.htm>.

Greene, Alan. "Respiratory Distress: A-Z Guide from Diagnosis to Treatment to Prevention." DrGreene. 13 Nov. 2013. 3 Mar. 2014 <http://www.drgreene.com/articles/respiratory-distress/>.

Schraufnagel, D. E., ed. Breathing in America: Disease, Progress, and Hope. American Thoracic Society, 2011.

Source: Medical Disability Advisor






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