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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.

Burn of Head and Neck (Including Face)


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Medical Codes

ICD-9-CM:
941.00 - Burn of Face and Head, Unspecified Site, Unspecified Degree
941.01 - Burn of Ear, Any Part, Unspecified Degree
941.03 - Burn of Lips, Unspecified Degree
941.04 - Burn of Chin, Unspecified Degree
941.05 - Burn of Nose (Septum), Unspecified Degree
941.06 - Burn of Scalp (Any Part), Unspecified Degree
941.07 - Burn of Forehead and Cheek, Unspecified Degree
941.08 - Burn of Neck, Unspecified Degree
941.09 - Burn of Multiple Sites of Face, Head, and Neck, Except Eye, Unspecified Degree
941.10 - First-degree Burn (Erythema) of Face and Head, Unspecified Site
941.11 - First-degree Burn (Erythema) of Ear (Any Part)
941.13 - First-degree Burn (Erythema) of Lips
941.14 - First-degree Burn (Erythema) of Chin
941.15 - First-degree Burn (Erythema) of Nose (Septum)
941.16 - First-degree Burn (Erythema) of Scalp (Any Part)
941.17 - First-degree Burn (Erythema) of Forehead and Cheek
941.18 - First-degree Burn (Erythema) of Neck
941.19 - First-degree Burn (Erythema) of Multiple Sites of Face, Head, Except with Eye
941.20 - Second-degree Burn, Blisters with Epidermal Loss of Face and Head, Unspecified Site
941.21 - Second-degree Burn, Blisters with Epidermal Loss of Ear (Any Part)
941.23 - Second-degree Burn, Blisters with Epidermal Loss of Lips
941.24 - Second-degree Burn, Blisters with Epidermal Loss of Chin
941.25 - Second-degree Burn, Blisters with Epidermal Loss of Nose (Septum)
941.26 - Second-degree Burn, Blisters with Epidermal Loss of Scalp (Any Part)
941.27 - Second-degree Burn, Blisters with Epidermal Loss of Forehead and Cheek
941.28 - Second Degree Burn, Blisters with Epidermal Loss of Neck
941.29 - Second-degree Burn, Blisters with Epidermal Loss of Multiple Sites of Face, Head, and Neck, Except with Eye
941.30 - Third-degree Burn, Full-thickness Skin Loss of Face and Head, Unspecified Site
941.31 - Third-degree Burn, Full-thickness Skin Loss of Ear, Any Part
941.33 - Third-degree Burn, Full-thickness Skin Loss of Lips
941.34 - Third-degree Burn, Full-thickness Skin Loss of Chin
941.35 - Third-degree Burn, Full-thickness Skin Loss of Nose (Septum)
941.36 - Third-degree Burn, Full-thickness Skin Loss of Scalp, Any Part
941.37 - Third-degree Burn, Full-thickness Skin Loss of Forehead and Cheek
941.38 - Third-degree Burn, Full-thickness Skin Loss of Neck
941.39 - Third-degree Burn, Full-thickness Skin Loss of Multiple Sites (Except with Eye) of Face, Head, and Neck
941.40 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Face and Head, Unspecified Site, without Mention of Loss of Body Part
941.41 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Ear, without Mention of Loss of Body Part
941.43 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Lips, without Mention of Loss of Body Part
941.44 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Chin, without Mention of Loss of Body Part
941.45 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Nose (Septum), without Mention of Loss of Body Part
941.46 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Scalp (Any Part), without Mention of Loss of Body Part
941.47 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Forehead and Cheek, without Mention of Loss of Body Part
941.48 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Neck, without Mention of Loss of Body Part
941.49 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Multiple Sites (Except with Eye) of Face, Head, and Neck, without Mention of Loss of Body Part

Related Terms

  • Facial Burn
  • Neck Burn

Overview

A burn is an injury to body tissues resulting from heat, electricity, chemicals, radiation, steam, or heated gases. Burns involving the head and neck are often characterized as severe burns because of potential injury to the eyes, ears, respiratory passages, and lungs. Burns impair the ability of the skin to prevent heat and water loss and protect against infection. According the rule of nines, used to assess the percentage of the total body surface area (TBSA) that has been burned, in adults the anterior head is estimated as 4.5% of the TBSA, and the posterior head is estimated as 4.5% of the TBSA.

Burns to the head, face, and neck are commonly due to heat (thermal) or chemical injury. Burns are often associated with smoking and alcohol use. Many burns occur in the home due to scalds from hot liquids or house fires. Flash and flame burns may result in inhalation injury.

Electrical burns are the least common burn injury and result from exposure to electrical current. Injury is caused as the current enters the body, passes through it, and again as it exits the body. The head is a common site for an electrical entrance wound.

Burns are described in degrees. A first-degree burn only affects the topmost layer of the skin (epidermis) and causes redness without any blistering. A common first-degree burn is sunburn. A second-degree burn involves deeper layers of the skin and results in painful blisters. Superficial second-degree burns often occur from scalds or short flashes. They are very painful but generally heal in about 3 weeks without scarring. Deeper second-degree burns are often caused from flames, oil, or grease and result in scarring. Third-degree burns involve burns through the entire layer of skin and the layer of tissue below the skin (subcutaneous tissue). Third-degree burns often appear very pale and cause little pain since all nerve endings have been destroyed. These burns may be due to flames, scalds, or chemical or electrical injuries. There are significant scars from this type of burn with development of abnormal stiffening of those joints involved in the injury (contractures). Fourth-degree burns are extremely deep and cause injury to the muscle and bone.

The area of skin surface injured, depth of the burn injury, and location determine the seriousness of burn injury. The skin of the eyelids is very thin (about 1 mm in thickness), allowing for increased severity. Severe burns also include inhalation injury, electrical burns, burns where other trauma has occurred, and burns in individuals at high-risk for complications or death, particularly for those over age 65, and with prior medical problems.

Individuals with significant facial burns often experience burns to the ears and may result in loss of the entire external ear.

Industries that place individuals at increased risk of burns to the head, face, and neck may include any manufacturing occupation involving the use of hot machinery or liquids. Occupations involving gas, propane, or other flammable liquids may also increase the risk of burns to the face, head, and neck.

The deployment of automobile airbags which may result in exposure to acid or alkali chemicals increases an individual's risk of burns.

Source: Medical Disability Advisor



Diagnosis

History: The individual or family reports exposure to flames, chemicals, electricity, or ultraviolet radiation and will usually report significant pain. There may be little pain if it is a third-degree burn. With steam or fires, there may be inhalation injury. The individual may have a history of cigarette smoking or alcohol use.

Physical exam: In first-degree burn, redness without blistering occurs as in facial sunburn. Large blisters may be apparent on the face in second-degree burn. The skin of the face and head may be very pale in third-degree burn. In fourth-degree burn, injury may extend into bone or muscle or the ears may be lost. A combination of burn depths may occur. The individual may have breathing difficulties. Associated injury includes burns to the eyes. In an electrical injury, both the entrance and exit wounds are noted with signs of injury between the two wounds.

Tests: For minor or moderate burns, testing is generally not needed. If ocular injury is suspected, it is important to determine visual acuity and estimate fields of vision. For severe burns, tests may include determination of the amount of oxygen in the blood (arterial blood gases), electrolytes, carboxyhemoglobin, blood urea nitrogen, blood sugar, and a complete blood count (CBC).

Source: Medical Disability Advisor



Treatment

Serious burns to the eyes, ears, and face usually require specialized care in a burn center because of the risk of significant scarring and loss of function. Breathing is a primary concern during initial evaluation and emergency treatment. The extent and duration of treatment vary depending on the area of body surface burned and any associated injuries.

Emergency treatment for first- and second-degree burns includes immersing the affected area in cool running water for 10 minutes or more until the burning feelings subside. If the victim is burnt through clothing, the clothing should be left on and immersed in water. Care must be taken when treating a chemical burn; in most circumstances, immediate and thorough flushing to remove any remaining chemical is appropriate. However, specific substances may require caution and lavage with substances other than water. Alkaline burns are more difficult to treat as the injury often progresses. Water lavage following exposure to lithium, potassium, phosphorus, and sodium may cause ignition. Exposure to hydrofluoric acid may cause progressive damage, and application of 2.5% calcium gluconate gel or injection of calcium gluconate or magnesium sulfate into the affected area may be beneficial. Individuals in contact with a live electrical source following an electrical burn should not be pulled away; the current should be switched off, if possible, or pushed away from the victim with a wooden stick or other item that does not conduct electricity. CPR and emergency treatment are needed if the victim has stopped breathing.

First-degree burns do not require treatment. Treatment of second-degree burns includes cleansing, removal of large blisters (debridement), and application of an antibacterial burn ointment and nonstick occlusive dressings. If the burn is expected to take longer than 3 weeks to heal, burned tissue (eschar) may be surgically removed (excised). Skin is taken from another area of the body and placed (grafted) on the burn to speed healing and minimize infection.

Third-degree burns require extensive treatment. The burn area is cleansed and dead tissue scraped off (d├ębrided). Severely burned skin becomes tight and rigid and is known as eschar. Eschar that encircles the neck and chest may restrict the ability to breathe and compress blood flow to vital organs. To release the tightness and allow breathing, an incision (escharotomy) may be needed along the neck. Repeated debridement may be necessary to fully determine the depth of the burn injury. Excision and grafting are usually done to minimize the frequency of debridement and prevent infection. If the victim has insufficient healthy skin remaining for grafting, bioengineered skin may be used. Reconstruction of facial defects is very challenging. Full-thickness skin grafts may be used but these may create problems at the donor site. Skin over the side of the chest is a good site for skin grafts because of its larger surface area, similar color, thickness, skin quality, and texture. Long-term treatment includes prevention of infection, excision and grafting, nutritional support, care of associated trauma and other medical conditions, plastic surgery to reconstruct facial structures if necessary, and rehabilitation.

Source: Medical Disability Advisor



Prognosis

Outcome is good for first-degree burns. First-degree burns to the head and neck heal in a few days without scarring. Outcome of superficial second-degree burns is good with healing in about 3 weeks without scarring or impairment of function. If the burn is deeper or if infection occurs, healing may take 3 to 9 weeks with significant scar formation.

Outcome of third- and fourth-degree burns is poor with significant scarring of the face. Skin grafting replaces skin permanently lost in the burn injury. The appearance of grafted skin may vary; it sometimes blends into nearby healthy skin very well but other times a distinct mark is noticeable between the normal and grafted skin.

Reconstruction of the nose and other areas of destroyed tissue improves cosmetic outcome. Following severe burns to the face, however, the individual's appearance may never be the same. In addition to damage to the nose, the ears and hair may be lost. Loss of vision may result from severe damage to the eyes. Inhalation injury associated with burns or the development of an infection may result in death.

Source: Medical Disability Advisor



Specialists

  • General Surgeon
  • Plastic Surgeon

Source: Medical Disability Advisor



Rehabilitation

The need for rehabilitation depends on the severity of the burn and any associated injuries. Deep second-degree burns and third-, and fourth-degree burns require several weeks to months for treatment and healing. Physical therapists trained in burn rehabilitation are important in the overall treatment for individuals experiencing burns to the head and neck.

Once the individual is stabilized, special compressive dressings or masks are measured and fitted by the physical therapist. These dressings are worn up to several months depending on the amount of potential scar formation. Neck and shoulder regions are monitored closely for potential stiffening of the joint region (joint contractures). If neck/shoulder mobility is restricted from the burn, the physical therapist initially performs passive range of motion exercises, and afterwards instructs the patient in active range of motion exercises, to prevent potential stiffening of the joint.

Once the range of motion is restored and the individual has advanced through the medical treatment process, strengthening of the neck and upper extremities become important in the rehabilitation process.

Occupational therapy becomes important for individuals with face/neck burns by helping them adapt to daily living activities if a loss of function occurred. Speech therapy is important in the rehabilitative process if the burn has affected speech and/or swallowing. Respiratory therapy helps the individual with any breathing difficulties. Psychological and social services may also be part of the rehabilitative team when the individual returns to work.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications include smoke and carbon monoxide inhalation, respiratory difficulty, eye injury, and any associated injuries. Burns to the ears may be complicated by inflammation of the ear cartilage (otochondritis). If the burn is caused from UV light reflecting off snow into unprotected eyes, or from welder's flash, painful conjunctivitis may result and is typically resolved with simple conservative treatment. With a third-degree burn to the head, there may be permanent hair loss. Infection can worsen the depth of a burn injury, necessitate skin grafting, and prolong healing time. It can also destroy skin grafts and necessitate a second skin graft procedure. In severe and extensive burns, kidney, liver, respiratory, and heart failure and overwhelming infection (sepsis) may be fatal.

Source: Medical Disability Advisor



Factors Influencing Duration

For small first-, second- (less than 15% of body surface area), and third-degree burns (less than 1% of body surface area), duration depends on site. The depth and severity of the burn influence the length of disability. Factors that may influence duration include age, sex, pre-existing conditions, and specific job duties.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations vary depending on severity of the burn. Restrictions are not necessary for minor burns of the face, neck, and head. For severe burns, several months of time off for recovery and surgical procedures may be necessary. The individual may have frequent follow-up appointments. Further reconstructive and plastic surgery may be required.

An individual with severe burns to the neck and head may no longer be able to perform normal activities. The individual may not be able to wear clothes with high or tight necklines especially if compressive dressings are needed to control scar formation. Wigs may be necessary if the hair is lost. A speakerphone may be necessary if dressings to the ears make it difficult to hold a handset phone to the ears. Individuals with severe scarring or loss of function due to severe burns to the neck and head may need counseling.

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:

  • Was the burn injury thermal, chemical, electrical, or a result of ultraviolet radiation?
  • Was the burn first-, second-, third-, or fourth-degree?
  • What percentage of body surface area was burned?
  • Was there smoke inhalation?
  • Did the burn affect the eyes? What other associated burns occurred?
  • What other associated injuries occurred?

Regarding treatment:

  • Was individual's breathing impaired? Was an incision made into the burn (escharotomy) to relieve breathing?
  • Has individual undergone repeated skin debridement?
  • Was excision and grafting performed?
  • Did infection occur?
  • How severe is scar formation?
  • What treatment was given for associated trauma such as burns to the eyes?
  • Was plastic surgery required to reconstruct facial structures?
  • Has individual started a physical rehabilitation program?
  • Is individual in need of speech or respiratory therapy?

Regarding prognosis:

  • Does individual have other conditions such as diabetes, heart disease, respiratory disease, immunosuppression or bleeding disorders, pre-existing liver or kidney disease, or malnutrition that may affect recovery?
  • How severely was individual burned?
  • What is age and sex of individual?
  • Would individual benefit from psychological counseling for body image changes and/or to cope with pain?
  • Have complications developed? If so, what are they and what is expected outcome with treatment?

Source: Medical Disability Advisor



References

Cited

"Burn Incidence Fact Sheet." American Burn Association. 2005. 4 Nov. 2009 <http://www.ameriburn.org/resources_factsheet.php>.

Bruns, Alan D., Don R. Revis, and Michael B. Seagel. "Facial Burns." eMedicine. Eds. Jennifer P. Porter, et al. 29 Jul. 2008. Medscape. 4 Nov. 2009 <http://emedicine.medscape.com/article/879183-overview>.

Das, Dipan, and Arun K. Gosain. "Burned Facial Skin." Essential Tissue Healing of the Face and Neck. Eds. David Hom, et al. Saunders Elsevier, 2009. 181.

Demling, Robert H., and Jonathan D. Gates. "Chapter 113: Medical Aspects of Trauma and Burn Care." Cecil Medicine. Eds. Lee Goldman, et al. 23rd ed. Saunders Elsevier, 2007. MD Consult. Elsevier, Inc. 4 Nov. 2009 <http://www.mdconsult.com/das/book/body/169079819-3/0/1492/443.html#4-u1.0-B978-1-4160-2805-5.50118-X--cesec26_4722>.

Donelan, Matthias B. "Reconstruction of the Head and Neck." Total Burn Care. Ed. David N. Herndon. 3rd ed. Saunders Elsevier, 2007. 701-714.

Edgar, Dale, and Megan Brereton. "Rehabilitation After Burn Injury." BMJ 329 7461 (2004): 343-345. PubMed. 4 Nov. 2009 <http://www.ncbi.nlm.nih.gov/pubmed/15297346>.

Source: Medical Disability Advisor