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.

Embolism, Pulmonary

embolism, pulmonary in русский (Россия)

Related Terms

  • PE
  • Pulmonary Thromboembolism
  • Pulmonary Thrombosis
  • Venous Thromboembolism

Differential Diagnosis

Specialists

  • Cardiologist, Cardiovascular Physician
  • Critical Care Internist
  • Internal Medicine Physician
  • Pulmonologist
  • Radiologist
  • Thoracic Surgeon

Comorbid Conditions

  • Heart disease
  • Obesity
  • Postphlebitic syndrome
  • Pulmonary disease

Factors Influencing Duration

Factors influencing the length of disability include advanced age, length of and response to anticoagulant therapy, underlying cause of the pulmonary embolus, degree of pulmonary dysfunction, and whether the individual required surgery.

Medical Codes

ICD-9-CM:
415.11 - Iatrogenic Pulmonary Embolism and Infarction
415.12 - Septic Pulmonary Embolism; Septic Embolism NOS
415.19 - Pulmonary Embolism, Other

Overview

Pulmonary embolism (PE) is a sudden blockage of the arterial circulation of the lungs by a fragment of biologic material (embolus) that obstructs blood flow through an artery. The blockage can occur in the main pulmonary artery that carries blood from the heart to the lungs or in one of the smaller arteries within the lung. In more than 50% of cases, the blockage arises from a blood clot originating in the veins of the legs (deep vein thrombosis [DVT]) that breaks loose, travels to the right side of the heart, and lodges in the pulmonary artery (Thompson). However, other substances can cause emboli in the pulmonary circulation. These include air from a central vein catheter, amniotic fluid dislodged in active labor, fat arising from long bone fractures, foreign bodies such as talc introduced during intravenous drug use, septic emboli as in acute endocarditis, or tumor cells.

In approximately one-third of cases, the blockage is temporary and causes no symptoms (Thompson). In the remainder, the blockage can cause chest pain with shortness of breath (dyspnea), a rapid respiratory rate (tachypnea), cough, coughing up blood (hemoptysis), and thigh or calf pain and / or swelling. Other symptoms such as sweatiness, anxiety, fainting (syncope), and rapid heart rate (tachycardia) may occur. PE can cause permanent lung damage through the death of lung tissue (pulmonary infarction). A massive PE can put enormous stress on the right ventricle and halt the entire circulatory system, causing cardiopulmonary arrest and death.

Incidence and Prevalence: There is an exponential increase in incidence with age, especially after age 40 (White). There are an estimated 100 cases of PE per 100,000 individuals per year in the US (Ouellette).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for PE are similar to those for DVT, and include prolonged bed rest or inactivity, surgery within the last 3 months, lower extremity or pelvic trauma, fracture, immobilization of a lower extremity, central venous instrumentation or intravenous catheterization within the last 3 months, cancer, chronic heart disease, pregnancy and childbirth, stroke, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), autoimmune diseases, oral contraceptive or estrogen replacement use, frequent air travel, heavy cigarette smoking, and obesity (Ouellette; Thompson; Torbicki; Faucher). More than 50% of individuals with confirmed DVT will go on to develop PE (Thompson).

The mean age of individuals with acute PE is 62 years with about 65% of those affected aged 60 years or older (Torbicki). Fatal PE is nearly twice as common in blacks than Caucasians (Ouellette).

Source: Medical Disability Advisor



Diagnosis

History: The individual may experience sudden dyspnea (73%) with chest pain (44%) that may radiate to the shoulder, jaw, neck, or arm. The chest pain may be described as worse with deep breathing (pleuritic). This may be combined with thigh or calf pain (44%), thigh or calf swelling (41%), coughing (34%) syncope, sweating, hemoptysis, a feeling of weakness, and anxiety (Thompson). The individual may complain of a rapid or irregular heartbeat. The individual may report having had a surgical procedure within the past 3 months, or active cancer (Thompson; Torbicki; White).

Physical exam: Typical findings include dyspnea, tachypnea (54%), and tachycardia (24%) (Thompson). Some individuals may present with a low-grade fever, bluish skin (cyanosis), and wheezing (21%) (Thompson). Listening to the chest may reveal abnormal lung sounds (rales) (18%) or an abnormal fourth heart sound. In cases of massive PE, the individual will display signs of shock (i.e., cold and clammy skin, weak pulse, low blood pressure).

Tests: Tests typically include chest x-ray, electrocardiogram (ECG), lung scans, arterial blood gases (ABG), and a complete blood count (CBC) in which white blood cell (WBC) counts may be elevated. D-dimer blood tests are performed to measure clot-related substances in the blood, and serve as a rapid screening test. Ischemia-modified albumin (IMA) and serum troponin levels may be obtained. Lung scans (ventilation-perfusion lung scans) use a radioactive substance to examine the flow of blood and oxygen to the parts of the lungs. Color-flow Doppler or duplex ultrasonography of the legs may be used to diagnose blood clots in the leg veins. A pulmonary angiogram (computed tomography [CT] angiography) is the most definitive test to diagnose pulmonary emboli. It involves injecting dye into the blood vessels and then taking x-ray pictures of the lungs to examine pulmonary blood flow. A spiral CT scan or magnetic resonance imaging (MRI) may be ordered on occasion as a noninvasive alternative for diagnosis.

Source: Medical Disability Advisor



Treatment

Treatment of PE initially focuses on immediately relieving symptoms of the attack with a combination of oxygen, rapidly administered blood-thinning drugs (anticoagulants), morphine, and fluids to stabilize low blood pressure (hypotension). If blood pressure remains low, intravenous vasopressor therapy with medications such as norepinephrine, dopamine, or epinephrine may be indicated. Anticoagulation therapy, the mainstay of PE treatment, is used for at least 3 months following the initial PE, and longer than 6 months in individuals with recurrent DVT or PE (NHLBI; Ouellette). Anticoagulants should not be used on individuals susceptible to bleeding due to other medical conditions such as esophageal varices, ulcers, and liver or kidney disease; in such individuals, surgical placement of a filter into the inferior vena cava (IVC filter) to block blood clots from traveling to the lungs may be necessary. If the individual remains in critical condition following the embolism and has not responded well to emergency measures, blood clot dissolving drugs (thrombolytics) such as recombinant tissue type plasminogen activator (tPA, alteplase), streptokinase (SK), or recombinant human urokinase (UK), may be administered over several hours intravenously (Tapson). Low-dose thrombolytic therapy may be combined with catheter-directed ultrasound to help break up the blood clot.

Removal of the embolus (pulmonary embolectomy) may be performed surgically, by injecting pressurized saline via a catheter to break up the clot, by advancing a rotating device into the clot through a catheter (catheter-directed rotational embolectomy), or by aspirating the clot out of the vessel using suction (suction embolectomy); these are emergency procedures done as a last resort.

Compression stockings (thrombo-embolism deterrent [TED] hose) may be used to decrease the risk of fluid pooling in the legs that may contribute to further blood clot formation. They are especially useful for individuals who had a precipitating DVT and may be used for 2 years or more after an acute PE to reduce the risk of post-thrombotic syndrome and recurrent DVT (Kanaan).

Source: Medical Disability Advisor



Prognosis

Since PE is a natural consequence of DVT, it is best to examine the prognosis of venous thromboembolism (VTE) to understand better the prognosis of PE. DVT is likely to resolve spontaneously after a few days in about one-third of the cases, but in over 50% of individuals an untreated DVT will likely develop into PE. The risk of VTE after surgery is highest during the first 2 weeks after surgery but remains elevated for up to 3 months.

Approximately 30% of individuals with untreated PE will die, and 3% to 8% of those with treated PE die within 30 days (Tapson). Death is strongly associated with age, cancer, and cardiovascular disease. Antithrombotic prophylaxis significantly reduces the risk of surgery-related VTE. The longer the duration of anticoagulant therapy, the lower the incidence of VTE. In individuals with previous VTE who had finished their course of at least 3 to12 months of anticoagulation treatment, the risk of fatal PE was less than 1% (Torbicki; White).

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation of an individual with PE begins once the origin and reason for the embolus is identified (e.g., surgery, immobilization, childbirth), and the situation is stabilized. The extent of rehabilitation will depend on the amount of damage resulting from the embolus and whether surgery was required to remove the embolus. Early ambulation is encouraged. If walking is not an option, the physical therapist or other rehabilitation professional may assign leg exercises to reduce the risk of clot formation.

When surgery is required, early rehabilitative exercises are critical in preventing further emboli since DVTs are particularly common after any operation. Rehabilitation is more extensive if the individual must regain strength and mobility following surgical removal of the pulmonary embolus. Early rehabilitation primarily focuses on preventing any breathing difficulties and regaining upper extremity range of motion that may have been lost due to surgery on the chest. A physical therapist experienced in cardiopulmonary rehabilitation keeps a daily log of the individual's blood pressure, heart rate, and cardiac rhythm. As the individual progresses with breathing and relaxation techniques, active assisted range of motion and then active range of motion exercises for the upper and lower extremities are added. As endurance continues to improve without dyspnea, strengthening exercises using light resistance and light aerobic activities such as brisk walking or low-resistance bicycling begin. The individual will progress to increased activities and exercises that simulate work.

Source: Medical Disability Advisor



Complications

Complications include lung collapse (atelectasis), pulmonary hypertension, fluid accumulation in the lung cavity (pleural effusion), shock due to low cardiac output, cardiopulmonary arrest, abnormal heart rhythms (arrhythmias), very low oxygen levels (hypoxemia), infection, and lung infarction. Death may occur.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Since PE usually is a result of a blood clot originating in the veins of the legs, it is vital for predisposed individuals to avoid sitting for prolonged periods. If long automobile or airplane trips are a part of job requirements, the individual should take periodic breaks from sitting to restore circulation.

The major concern while taking anticoagulant drugs is the increased risk of bleeding; therefore, the individual should avoid high-risk tasks such as heavy labor that may precipitate bleeding, or tasks that may cause falls or cuts.

For more information on risk, capacity, and tolerance, refer to "Work Ability and Return to Work," pages 310-311.

Source: Medical Disability Advisor



Maximum Medical Improvement

180 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:

  • Did individual have chest pain with dyspnea, cough, tachypnea, hemoptysis, and thigh or calf pain and / or swelling? Is individual cyanotic?
  • Did individual have risk factors such as prolonged bed rest or inactivity, surgery or catheterization within the last 3 months, femur or pelvic trauma, fracture, immobilization of a lower extremity, cancer, chronic heart disease, childbirth, stroke, CHF, COPD, autoimmune disease, oral contraceptive use, frequent air travel, or obesity? Is individual a heavy smoker?
  • Did individual have previous DVT?
  • On exam, did individual have tachycardia, tachypnea, chest pain, wheezing, and syncope?
  • Did individual have abnormal lung or heart sounds?
  • Did the individual have clammy skin, weak pulse, and hypotension?
  • Has individual had a chest x-ray, ECG, ventilation-perfusion lung scan, arterial blood gases, and CBC? D-dimer test? IMA and serum troponin levels?
  • Did individual have a pulmonary angiogram, CT scan, or MRI? Color-flow Doppler or duplex ultrasonography of the legs?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is individual being treated with oxygen, anticoagulants, morphine, and fluids?
  • Was it necessary to use thrombolytics?
  • Was IVC filter needed? Catheter-directed embolectomy?
  • Did it become necessary to perform surgery?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Does individual have any complications such as atelectasis, pulmonary hypertension, arrhythmias, shock due to low cardiac output, cardiopulmonary arrest, infection, or lung infarction?

Source: Medical Disability Advisor



References

Cited

Faucher, L. D. , and K. M. Conlon. "Practice Guidelines for Deep Venous Thrombosis Prophylaxis in Burns." Journal of Burn Care and Research 28 (2007): 661-663.

Garg, Kavita. "Acute Pulmonary Embolism (Helical CT)." eMedicine. Eds. Eugene C. Lin, et al. 10 Apr. 2013. Medscape. 15 May 2014 <http://emedicine.medscape.com/article/361131-overview>.

Kanaan, A. O. , et al. "Evaluating the Role of Compression Stockings in Preventing Post Thrombotic Syndrome: A Review of the Literature." Thrombosis 2012 (2012): 694851.

National Heart Lung and Blood Institute. "Pulmonary Embolism." National Heart Lung and Blood Institute. 1 Jul. 2011. U.S. National Institutes of Health. 3 Jul. 2014 <http://www.nhlbi.nih.gov/health/dci/Diseases/pe/pe_what.html>.

Ouellette, Daniel R. "Pulmonary Embolism." eMedicine. Eds. Zab Mosenifar, et al. 28 Apr. 2014. Medscape. 15 May 2014 <http://emedicine.medscape.com/article/300901-overview>.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Tapson, Victor F. "Treatment of Acute Pulmonary Embolism." Up to Date. Ed. Jess Mandel. 25 Mar. 2014. Wolters Kluwer Health. 3 Jul. 2014 <http://www.uptodate.com>.

Thompson, B. Taylor, and Charles A. Hales. "Overview of Acute Pulmonary Embolism." Up to Date. 3 Jun. 2014. Wolters Kluwer Health. 3 Jul. 2014 <http://www.uptodate.com>.

Torbicki, A. , et al. "Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)." European Heart Journal 29 (2008): 2276-2315.

White, R. H. "The Epidemiology of Venous Thromboembolism." Circulation 107 (2003): 1-4-1-8.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.