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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 Trunk


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Medical Codes

ICD-9-CM:
942.00 - Burn of Trunk; Unspecified Degree, Trunk, Unspecified Site
942.01 - Burn of Trunk; Unspecified Degree, Breast
942.02 - Burn of Trunk; Unspecified Degree, Chest Wall, excluding Breast and Nipple
942.03 - Burn of Trunk; Unspecified Degree, Abdominal Wall; Flank; Groin
942.04 - Burn of Trunk; Unspecified Degree, Back [Any Part]; Buttock; Interscapular Region
942.05 - Burn of Trunk; Unspecified Degree, Genitalia; Labium (Majus) (Minus); Penis; Perineum; Scrotum; Testis; Vulva
942.09 - Burn of Trunk; Unspecified Degree, Other and Multiple Sites of Trunk
942.10 - Burn of Trunk; Erythema [First Degree], Trunk, Unspecified Site
942.11 - Burn of Trunk; Erythema [First Degree], Breast
942.12 - Burn of Trunk; Erythema [First Degree], Chest Wall, excluding Breast and Nipple
942.13 - Burn of Trunk; Erythema [First Degree], Abdominal Wall; Flank; Groin
942.14 - Burn of Trunk; Erythema [First Degree], Back [Any Part]; Buttock; Interscapular Region
942.15 - Burn of Trunk; Erythema [First Degree], Genitalia; Labium (Majus) (Minus); Penis; Perineum; Scrotum; Testis; Vulva
942.19 - Burn of Trunk; Erythema [First Degree], Other and Multiple Sites of Trunk
942.20 - Burn of Trunk; Blisters, Epidermal Loss [Second Degree], Trunk, Unspecified Site
942.21 - Burn of Trunk; Blisters, Epidermal Loss [Second Degree], Breast
942.22 - Burn of Trunk; Blisters, Epidermal Loss [Second Degree], Chest Wall, excluding Breast and Nipple
942.23 - Burn of Trunk; Blisters, Epidermal Loss [Second Degree], Abdominal Wall; Flank; Groin
942.24 - Burn of Trunk; Blisters, Epidermal Loss [Second Degree], Back [Any Part]; Buttock; Interscapular Region
942.25 - Burn of Trunk; Blisters, Epidermal Loss [Second Degree], Genitalia; Labium (Majus) (Minus); Penis; Perineum; Scrotum; Testis; Vulva
942.29 - Burn of Trunk; Blisters, Epidermal Loss [Second Degree], Other and Multiple Sites of Trunk
942.31 - Burn of Trunk; Full-thickness Skin Loss [Third Degree NOS], Breast
942.32 - Burn of Trunk; Full-thickness Skin Loss [Third Degree NOS], Chest Wall, excluding Breast and Nipple
942.33 - Burn of Trunk; Full-thickness Skin Loss [Third Degree NOS], Abdominal Wall; Flank; Groin
942.34 - Burn of Trunk; Full-thickness Skin Loss [Third Degree NOS], Back [Any Part]; Buttock; Interscapular Region
942.35 - Burn of Trunk; Full-thickness Skin Loss [Third Degree NOS], Genitalia; Labium (Majus) (Minus); Penis; Perineum; Scrotum; Testis; Vulva
942.39 - Burn of Trunk; Full-thickness Skin Loss [Third Degree NOS], Other and Multiple Sites of Trunk
942.40 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] without Mention of Loss of a Body Part, Trunk, Unspecified Site
942.41 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] without Mention of Loss of a Body Part, Breast
942.42 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] without Mention of Loss of a Body Part, Chest Wall, excluding Breast and Nipple
942.43 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] without Mention of Loss of a Body Part, Abdominal Wall; Flank; Groin
942.44 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] without Mention of Loss of a Body Part, Back (Any Part); Buttock; Interscapular Region
942.45 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] without Mention of Loss of a Body Part, Genitalia; Labium (Majus) (Minus); Penis; Perineum; Scrotum; Testis; Vulva
942.49 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] without Mention of Loss of a Body Part, Other and Multiple Sites of Trunk
942.50 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] with Loss of a Body Part, Trunk, Unspecified Site
942.51 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] with Loss of a Body Part, Breast
942.52 - Burn of Trunk; Flank; Groin; Buttock; Interscapular Region; Labium (Majus) (Minus); Penis; Perineum; Scrotum; Testis; Vulva; Deep Necrosis of Underlying Tissues [Deep Third Degree] with Loss of a Body Part, Chest Wall, Excluding Breast and Nipple
942.53 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] with Loss of a Body Part, Abdominal Wall; Flank; Groin
942.54 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] with Loss of a Body Part, Back (Any Part); Buttock; Interscapular Region
942.55 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] with Loss of a Body Part, Genitalia; Labium (Majus) (Minus); Penis; Perineum; Scrotum; Testis; Vulva
942.59 - Burn of Trunk; Deep Necrosis of Underlying Tissues [Deep Third Degree] with Loss of a Body Part, Other and Multiple Sites of Trunk

Related Terms

  • Burn of the Back
  • Burn of the Buttocks
  • Burn of the Chest
  • Burn of the Flank
  • Burn of the Genitalia
  • Burn of the Groin
  • Burn of the Interscapular Region

Overview

A burn is injury to body tissue produced by exposure to heat (e.g., flame, scalding liquids, steam), chemicals, electricity, friction or radiation. Burns compromise the skin’s normal ability to prevent loss of heat and water and to protect the body from infection. Additionally, burns may compromise blood circulation, damaging cells within skin layers and eventually resulting in tissue death (necrosis). Burns are extremely complex and interfere with body metabolism and the functioning of major organ systems.

The trunk represents 36% of the total body surface area (TBSA) and includes the chest, flank, groin, back, buttocks, and genitalia. Burns of the trunk will be evaluated for depth and amount of surface area damaged to determine burn severity and appropriate therapy. The extent of tissue damage is expressed as a percentage of the TBSA and may be classified further as major, moderate, or minor. An assessment method called “the rule of nines” allows physicians to quickly estimate the surface area of the burn and related risk. Head and neck represent 9%, upper limbs are each 9%, anterior and posterior trunk each represent 18%, anterior and posterior portions of the lower limbs are each 9%, and external genitalia are 1%.

Age is an important factor in burn outcomes because epidermal thickness varies with age, influencing depth of injury. Young children and elderly individuals, for example, have thinner layers and are at greater risk of full-thickness burns.

Burns are characterized as first-, second-, third-, or fourth-degree according to depth of injury. First-degree burns affect only the outermost layer (epidermis) of the skin, causing redness without blistering. Tissue damage is minor and the protective functions of the skin remain intact. Sunburn is an example of a first-degree burn.

Second-degree burns, also called partial-thickness burns, damage the outer epidermis and the underlying tissue layer (dermis). Partial-thickness burns can be either superficial or deep depending on the extent of damage. Blistering is the most notable sign of second-degree burns; fluid-filled blisters are typically seen on a pink, moist and soft burn area. Blisters usually heal without scarring and require only minor treatment. Second-degree burns are most often caused by scalds from hot liquids, hot oil or grease spills, or short exposure to flames.

Third degree, or full thickness burns, damage or destroy the deepest layers of skin including the dermis, its nerve endings, and fatty connective tissue of the subcutaneous layer. Because nerve endings have been destroyed, these burns may be pale and produce little pain initially. Skin damage may result in significant scarring. These burns are caused by flames, immersion scalds, chemical exposures, and electrical injuries and are classified as severe.

Fourth-degree burns are even more severe, affecting the epidermis, dermis and subcutaneous layers, as well as underlying muscle tissue and bone. Tissue damage and impaired circulation may be irreversible, requiring extensive surgical removal of dead and damaged tissue (débridement) and reconstruction. These burns are caused by longer exposure to the same thermal sources that cause third-degree burns.

The skin acts as a protective barrier against bacteria, fungi, and viruses. Burns damage that protective function and also damage local immune system cells (Langerhans cells), affecting immune system functioning and leaving the individual vulnerable to local and systemic infection until the burn heals. The skin also plays a vital role in temperature regulation, and its extensive vascular network is an important blood reservoir. The effect of burn damage on these functions can cause heat loss, impede blood flow and coagulation, and increase inflammatory response in the burn area.

Severe burns also result in significant loss of body fluids leading to dehydration and electrolyte imbalances that can, in turn, affect heart function, blood pressure, and circulation.

Incidence and Prevalence: Nearly 700,000 Americans are treated for burns at emergency departments each year; 45,000 are admitted to hospitals or burn centers (Goodis; Edlich). The highest incidence of burn injuries occurs in young adults between ages 20 and 29 years and in children younger than age 9. More serious burns occur in males (67%) than in females, and 25% of burns are work related (Edlich).

Source: Medical Disability Advisor



Diagnosis

History: The individual usually will report pain except in third-degree burns in which nerve endings are damaged. The history will include the cause of the burn, the age and health status of the individual, and other injuries sustained.

Physical exam: Physical findings vary with burn severity, including redness without blistering for first-degree burns, large blisters in second-degree burns, pale skin and tissue swelling (edema) in third-degree burns, and deep injury extending into muscle or bone in fourth-degree burns. Severely affected tissue may be blackened and leathery or range in color from white or brown to bright red.

Entrance and exit wounds may be seen in electrical burns. When high-voltage electrical current passes through the body, small, deep holes may be found at the point where it first makes contact. Electrical burns may not produce noticeable changes in the outer layer of skin, but severe underlying damage to muscle and bone tissue may be present, as well as interrupted blood flow.

Tests: Laboratory tests usually are not needed for diagnosing first- and second-degree burns. Diagnostic evaluation for deeper, more severe burns may include a complete blood count (CBC), blood urea nitrogen (BUN), blood glucose, electrolytes (sodium, potassium and chloride), coagulation tests, and blood gases. Other laboratory tests may include urinalysis to determine fluid status and serum myoglobin to evaluate muscle destruction. Imaging studies may be performed to evaluate suspected muscle and bone damage. Fiberoptic bronchoscopy may be done for suspected inhalation injury.

When burns occur as the result of exposure to fire, blood carboxy-haemoglobin (COHb) levels should be checked. If results are greater than 60%, the outlook is very poor. At lower levels, hyperbaric oxygen therapy may be life-saving, since oxygen at three atmospheres reduces the half life of COHb to about 20 minutes, and dissolves sufficient oxygen in the plasma to maintain life.

Source: Medical Disability Advisor



Treatment

Emergency treatment for first- and second-degree burns may begin by rinsing the burned area and, in the case of chemical burns, removing contaminated clothing. Constrictive clothing must be removed promptly to avoid a “tourniquet effect” that can develop as edema increases. If the individual has been exposed to flame or a structure fire, potential airway inhalation injury will be evaluated and may require intubation or CPR to provide adequate oxygen intake. Moderate and severe burns require intravenous fluid replacement. Tetanus boosters are given routinely and, depending upon severity, nonsteroidal anti-inflammatory drugs (NSAIDs) drugs or intravenous opioids may be given to relieve pain. In first- and second-degree burns, cool compresses are applied to the burn site to relieve pain. The burn wound often requires debridement, washing, and, when the skin is broken, covering with an antibiotic ointment.

In third- and fourth-degree burns, intravenous fluid replacement is needed to prevent shock and maintain cardiac output. In the first 24 hours, the initial fluid intake is typically 4 mL/kg of body weight per percent of body surface area burned. A Foley catheter may be inserted in the bladder to measure urinary output and to help monitor fluid replacement needs.

Edema sometimes develops under dead tissue in the burned area (eschar). A “tourniquet effect” caused by edema can block blood circulation, causing dramatic increases in tissue pressure. To release fluid pressure, the physician may make incisions through the overlying tissue (escharotomy or fasciotomy).

Burn cases resulting from fires may require use of a hyperbaric chamber that administers oxygen at higher than normal atmospheric pressure to the individual to treat carbon monoxide and/or cyanide exposure and to enhance oxygenation of damaged tissue. Infection is the leading cause of death in hospitalized burn patients. Surgical removal (excision) of infected tissue often is required.

Based on the extent and depth of the burn, the emergency physician will determine whether the patient requires the special care provided at a burn center, of which there are 125 in the US. The American Burn Association recommends transfer to a burn center for second-degree burns covering over 10% total body surface area; third-degree burns covering over 5% of total body surface area; second-degree or third-degree burns involving critical areas such as major joints, feet, hands, or face; burns with associated inhalation injury; and electrical or lightning burns. Burn centers typically perform serial operations on individuals with severe or third-degree burns. One or more operations to débride dead tissue may be followed by skin grafting or by surgical placement of temporary skin substitutes. Skin grafting is frequently the final stage.

Long-term care will address infection prevention, associated psychological trauma, and nutritional support. A severe burn destroys protein (amino acids) and may result in drastic weight loss during recovery, requiring up to 9000 calories per day to maintain energy balance. Plastic surgery may be performed, and long-term rehabilitation may necessary.

Source: Medical Disability Advisor



Prognosis

Uncomplicated first and second-degree burns of the trunk generally heal uneventfully. Severe burns may result in permanent disfigurement and scarring, loss of mobility, or death. General prognosis depends on depth and extent of the burn, the individual’s age, other injury associated with the burn, and comorbid conditions.

Most fire deaths are caused by inhalation of smoke or toxic substances rather than by burns. Of deaths attributed specifically to burns, most are the consequence of exposure to flame; burns by scalding represent the second highest number of deaths. Survival rates for burn patients have improved steadily over the past two decades with improved firefighting techniques, advances in topical antibiotic therapy for wounds, earlier excision and grafting, more effective management of burn shock, and improved emergency response and intensive care management in burn centers.

Source: Medical Disability Advisor



Specialists

  • General Surgeon
  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physical Therapist
  • Plastic Surgeon

Source: Medical Disability Advisor



Rehabilitation

The goals of rehabilitation are a return to pre-injury levels of strength, ambulation, cardiovascular endurance, range of motion (ROM), and activities of daily living (ADL). In addition, rehabilitation plays an important role in minimizing scar formation, controlling edema, and reducing the risk of secondary impairments. Active patient participation is crucial to a successful outcome.

To achieve those goals, the therapist will tailor established modalities to suit the individual’s requirements. These include massage, pressure dressings, positioning, splinting, and a progressive program of active and passive exercise.

Massage is helpful in returning suppleness to the burned tissue by breaking down adhesions and new scar tissue. Additionally, the therapist may select from a variety of pressure dressings to reduce scarring and edema as well as to enhance circulation to the skin grafts. The dressings include a variety of elastic wraps, tubular support bandages, and pressure garments. Generally, pressure garments are reserved to prevent contractures or the need for skin grafting. Burned areas are usually maintained in a neutral position to avoid further tissue destruction and to control edema.

A program of exercise corresponding to normal range of motion begins as soon as the patient is capable. Ideally, this would be on the first day unless it interferes with the establishment of newly grafted skin. As the individual improves, the therapist will add appropriate strengthening and endurance regimens. Before discharge, the burn unit team should provide the patient with a program of skin care, positioning, and exercise to be followed at home. Follow-up monitoring and modification are essential.

Source: Medical Disability Advisor



Comorbid Conditions

  • Bleeding disorders
  • Compromised immune system
  • Fractures or burns of the limbs
  • Malnutrition
  • Pre-existing kidney or liver disease
  • Pulmonary inhalation injury

Source: Medical Disability Advisor



Complications

Most minor burns to the trunk cause no complications. However, more serious burns may result in infection, uncontrolled edema, scarring, contraction tissue that restricts movement, and interrupted circulation. Emergency escharotomy may be performed to relieve pressure. If underlying muscle has been destroyed, oxygen-carrying protein (myoglobin) can enter the blood stream and result in kidney damage.

Burn patients receiving large amounts of fluids are at risk for developing dangerous elevation in intra-abdominal pressure (abdominal compartment syndrome), a serious condition that, if left unrelieved, may have potentially fatal consequences due to cardiovascular, pulmonary, and renal compromise. Surgical opening of the abdomen for several days may be required.

Source: Medical Disability Advisor



Factors Influencing Duration

The site, depth, and severity of the burn influence the length of disability. Factors that may influence duration include age, gender, 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 the severity of the burn. Limitations are usually unnecessary for minor burns of the trunk. Severe burns may require several months of time off for recovery and multiple surgical procedures. The individual may require compressive dressings for several months to minimize scar formation and for comfort. Scarring and tissue damage may cause permanent disability or may require special adaptive equipment and job accommodations. Frequent follow-up appointments often accompany burns of the trunk. Disfigurement is sometimes accompanied by psychological trauma, which may also require regular counseling appointments.

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:

  • Did the burn involve thermal, chemical, electrical, or ultraviolet radiation injury?
  • What percentage of body surface area was burned?
  • How deep was the burn? Was muscle, nerve, or bone damage involved?
  • What other associated burns or injuries occurred?
  • Was pulmonary function compromised by inhalation injury?
  • Was individual’s health compromised by pre-existing chronic illness?

Regarding treatment:

  • Was damage from a chemical burn reduced by removing causative chemical and contaminated clothing immediately?
  • Were shock and circulatory dysfunction avoided by adequate fluid replacement?
  • Was airway inhalation injury (if present) treated?
  • For more severe burns, were excision and grafting performed?
  • Was intra-abdominal pressure monitored in the presence of large volumes of replacement fluid?
  • Was repeated debridement of the burn area required?
  • Was nutritional support provided during healing?
  • Was a program of exercise prescribed to maintain flexibility and movement?

Regarding prognosis:

  • How severe is scar formation?
  • Did infection develop? If so, was individual compliant with antibiotic treatment?
  • Are underlying conditions present that could prevent healing and prolong recovery?
  • Have recommendations been made regarding nutritional needs following hospital discharge?
  • Has the individual begun a physical rehabilitation program? Is individual compliant with rehabilitation?
  • Would individual benefit from psychological and occupational therapy?

Source: Medical Disability Advisor



References

Cited

Edlich, R. F., M. L. Martin, and W. Long. "Thermal Burns." Rosen's Emergency Medicine: Concepts and Clinical Practice. Eds. J. A. Marx, et al. 6th ed. Philadelphia: Mosby Elsevier, 2006. 11365-1368.

Goodis, Jamie, and Erik Schraga. "Burns, Thermal." eMedicine. Eds. Debra Slapper, et al. 29 Oct. 2008. Medscape. 13 Feb. 2009 <http://emedicine.medscape.com/article/769193-overview>.

General

Cohen, Richard, Brent Moelleken, and . "Disorders Due to Physical Agents." Current Medical Diagnosis & Treatment. 43rd ed. New York: McGraw-Hill, 2004. 1534-1537.

Source: Medical Disability Advisor