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.

Pleural Empyema


Related Terms

  • Empyema thoracis
  • Pleural Abscess
  • Pyothorax

Specialists

  • General Surgeon
  • Infectious Disease Internist
  • Pulmonologist
  • Thoracic Surgeon

Comorbid Conditions

Factors Influencing Duration

Factors influencing duration of disability include age, response to treatment, cause of pleural empyema, comorbid conditions, presence of any complications, and type of work the individual is expected to perform. Individuals with sedentary positions usually have a shorter disability period. Conversely, individuals who perform heavy work or whose jobs are physically demanding will require a longer period of recovery before returning to full work capacity.

Medical Codes

ICD-9-CM:
510.0 - Empyema with Fistula
510.9 - Empyema without Mention of Fistula

Overview

© Reed Group
The pleura is a membrane that lines the lung (visceral pleura) and the chest cavity (parietal pleura); the pleural cavity is a virtual space between visceral and parietal pleura which normally contains a small amount of liquid called pleural fluid. Pleural empyema is an accumulation of pus in the pleural cavity that occurs when an infection spreads from the lungs. This pus contains dead white blood cells that fought infection (polymorphonuclear leukocytes) and blood proteins involved in clotting (fibrin). When pus builds up in the pleural cavity, it puts pressure on the lung and results in shortness of breath and pain. As fibrin is laid down, it separates the pleural fluid into tiny pockets (loculation). Formation of scar tissue can entrap sections of lung and cause permanent lung damage.

Pleural empyema is usually a complication of a lung infection (pneumonia) or a localized pocket of pus (abscess) in the lung. It may also result from an infection after chest surgery (postoperative infection), a traumatic penetrating chest injury, or a medical procedure that invades the chest such as thoracentesis or insertion of a chest tube. Pus from an abscess in the abdomen just beneath the lungs (subphrenic abscess) may also spread to the pleural cavity and result in pleural empyema. Pleural empyema can occur as a complication of many other conditions, including septicemia, septic thrombophlebitis, spontaneous pneumothorax, mediastinitis, or esophageal rupture.

Incidence and Prevalence: The incidence of pneumonia complicated with pleural empyema seems to be on the rise. The rate of pleural empyema among children < 2 years old increased 2 fold from 3.5 cases per 100,000 children in 1996-1998 to 7.0 cases per 100.000 in 2005 – 2007. An even larger increase (2.81) was seen among children aged 2-4 from 3.7 per 100,000 children to 10.3 per 100,000 (Grijalva). Similarly, the incidence of this important complication on pneumonia is increasing among adults. (Burgos).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors include bacterial pneumonia, chest surgery, lung abscess and trauma or injury to the chest (Vyas).

Source: Medical Disability Advisor



Diagnosis

History: In most cases, the individual reports a current or recent episode of pneumonia or a lung abscess. Often, symptoms are present for days before the diagnosis of pleural empyema is made. Chest pain is often reported and may be described as sharp pain that worsens when inhaling, coughing, or sneezing. Other common symptoms include dry cough, difficulty breathing (dyspnea), chills, night sweats, a general feeling of illness (malaise), loss of appetite (anorexia), and unintended weight loss.

Physical exam: The individual usually has a mild to moderate fever, rarely in excess of 102° F (38.9° C). Rapid, shallow breathing may be noted as the individual tries to avoid deep breaths. Listening to the chest with a stethoscope (auscultation) reveals decreased breath sounds, wheezing, and in individuals with pneumonia a creaky sound in the chest (crackles). Asking the individual to speak while listening to the lungs may reveal a characteristic sound called egophony. Tenderness to pressure may occur over the chest wall adjoining the pleural empyema. The breath may have a foul odor.

Tests: A standard chest x-ray may or may not be helpful and can appear normal if only a small volume of pus is present. X-ray taken with the individual lying on the side can detect a smaller effusion. Extensive pneumonia can obscure the pleural empyema. It may be difficult to recognize a localized pleural empyema.

A blood test often reveals an abnormally high level of white blood cells.

A definite diagnosis of pleural empyema can only be made by obtaining a sample of pleural fluid, examining it microscopically, and culturing it. The fluid can be drawn out through a needle (thoracentesis) or during the insertion of a chest tube for drainage (thoracostomy). Ultrasonography and/or computed tomography (CT) can also play a role in guiding and/or monitoring the treatment of pleural empyema. If the amount of fluid seen on x-ray is small and the patient is clinically improving, the physician may elect to monitor the accumulation over time before undertaking an invasive diagnostic procedure.

Source: Medical Disability Advisor



Treatment

Pleural empyema is usually treated on an inpatient basis with intravenous antibiotics for the underlying infection. Prompt drainage of the accumulated pus is important. Although removal of pus with a needle (thoracentesis) can provide immediate relief, fluid usually reaccumulates quickly. Insertion of a chest tube (thoracostomy) allows continuous drainage of fluid. The individual's breathing (respiratory) status is monitored closely so respiratory assistance can be provided, as needed. Pain medication (analgesics) may be prescribed, if needed. If the pleural fluid collections are separated into smaller areas because of fibrin deposition (loculated), a medication to break up the fibrin (fibrinolytic), such as urokinase, may be instilled into the chest cavity. A surgeon may need to manually open and drain the fluid pockets (decortication) if the lung does not expand properly.

A pleural empyema may require many weeks to resolve. Once the underlying infection is controlled and the respiratory status is stable, individuals can be discharged from the hospital with a chest tube and drainage bag in place.

Source: Medical Disability Advisor



Prognosis

The outcome for pleural empyema varies significantly, depending on the underlying cause, promptness of treatment, and severity of individual's symptoms. In most cases, antibiotic therapy and prompt, continuous drainage of fluid provide complete recovery without permanent damage to the lungs. However, full recovery may require several days of hospitalization and several weeks of at-home recovery.

Source: Medical Disability Advisor



Rehabilitation

If pneumonia is associated with pleural empyema, respiratory therapy may be helpful to loosen secretions and promote deeper breathing.

Source: Medical Disability Advisor



Complications

Pus can become walled off into pockets (loculated), making it harder to treat. The bacteria causing pleural empyema may be resistant to multiple antibiotics and make treatment more difficult and prolonged. Air can enter into the pleural space (pneumothorax), and scarring of the lungs (pulmonary fibrosis) can occur. Pleural thickening may also occur.

If left untreated, an erosion can occur between the breathing passages (bronchial tree) and the pleural space (bronchopleural fistula) or between the pleural space and the skin (empyema necessitatis). Respiratory failure and septic shock are extreme complications that can result in death.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions required depend on the individual's course of recovery and any complications. Prolonged sick leave is necessary for recovery. Upon return to work, flexibility in the work schedule may be needed to accommodate frequent checkup visits to the physician or rest breaks, as needed. Heavy lifting and physically demanding jobs may need to be limited.

Risk: No job should put a person who has healed from pleural empyema at increased risk of future recurrence. If the pleural empyema patient is an immune-compromised individual, then working with heavy public contact, indigent or incarcerated populations, health care settings, may place the individual at increased risk of further or recurrent infection. Some risk can be mitigated by frequent hand washing, gloves or masks. Universal blood and body fluid precautions must be exercised.

Capacity: In absence of complications or underlying illnesses, once healed, there should be no impact on capacity. Objective testing with chest X-ray, chest CT, pulmonary function tests (PFT) and/or stress echocardiography (ECHO) would confirm this impression.

Tolerance: In absence of complications or underlying illnesses, no impact on tolerance once healed would be expected.

Source: Medical Disability Advisor



Maximum Medical Improvement

90 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:

  • Has individual recently had pneumonia or a lung abscess?
  • Has individual undergone recent chest surgery, insertion of a chest tube, or thoracentesis?
  • Has individual experienced recent trauma to the chest from a penetrating injury?
  • Has individual had septicemia, mediastinitis, or esophageal rupture?
  • Does individual report sharp chest pain that worsens on inhaling, coughing, or sneezing? Does individual have difficulty breathing (dyspnea), chills, night sweats, a general feeling of illness (malaise), loss of appetite (anorexia), and unintended weight loss?
  • Was a sample of pleural fluid taken for exam and culture and for definitive diagnosis?
  • Was a chest x-ray, ultrasound, and/or CT required?
  • Was the diagnosis of pleural empyema confirmed?
  • What is the underlying cause of the infection?

Regarding treatment:

  • Was individual hospitalized to receive intravenous antibiotics and for drainage of the accumulated pus?
  • Was insertion of a chest tube (thoracostomy) done to allow for continuous drainage?
  • If fibrin deposits are involved, did individual receive medication to dissolve the fibrin deposits (fibrinolytics)?
  • Did individual receive pain medication (analgesics)?
  • Were chest tubes and drainage bags left in place when individual was discharged from the hospital?
  • Was individual compliant with the treatment regimen, including medications, at-home care, and follow-up examinations?

Regarding prognosis:

  • Was the underlying cause promptly identified and treated?
  • Was antibiotic therapy specific for the organism causing the infection?
  • Was individual allowed several weeks of at-home recovery?
  • Has individual complied with all medical instructions?
  • Did individual develop a pneumothorax?
  • Has lung scarring (pulmonary fibrosis) occurred?
  • Have complications that could lengthen disability developed, such as loculation, bronchopleural fistula, or sepsis?
  • Does individual have underlying illnesses, such as immune system disorders or chronic lung disease, that may affect recovery?

Source: Medical Disability Advisor



References

Cited

Burgos, J., V. Falco, and A. Pahissa. "The Increasing Incidence of Empyema." Current Opinion in Pulmonary Medicine 19 (2013): 350-356.

Grijalva, C. G. , et al. "Increasing Incidence of Empyema Complicating Childhood Community-Acquired Pneumonia in the United States." Clinical Infectious Diseases 50 (2010): 805-813.

Tobler, Marc. "Empyema Imaging." eMedicine. Eds. Barry H. Gross, et al. 1 Nov. 2013. Medscape. 31 Oct. 2014 <http://emedicine.medscape.com/article/355892-overview>.

Vyas, Jatin M. "Empyema." Medline Plus. 29 Jan. 2013. USDHHS. 31 Oct. 2014 <http://www.nlm.nih.gov/medlineplus/ency/article/000123.htm>.

Source: Medical Disability Advisor






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