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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.

Insect or Spider Bites and Stings


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
989.5 - Toxic Effects, Insect or Spider Bites and Stings

Related Terms

  • Bee Sting
  • Spider Bite

Overview

Image Description:
Insect or Spider Bites and Stings - The back of the right hand is shown with a bee sting highlighted at its center. A close-up of the bee sting reveals a hole at its center with a small swollen area and inflammation surrounding it.
Click to see Image

Syndromes caused by insect or spider (arthropods) stings or bites are a result of the injected toxic venom. They can be caused by direct toxic effects and/or hypersensitivity to the venom, the organism, or their by-products or from transmission of microorganisms carried by the insect (malaria, Lyme disease). Stinging insects (Hymenoptera) include wasps, bees, and ants. Other stinging insects (arthropods) include spiders, scorpions, ticks, and mites. Biting insects include lice, bedbugs, fleas, and mosquitoes.

The reaction to a bite or sting may be local or systemic, and it can develop in a minute or up to several hours after the initial insult. Insect and spider toxins may cause local pain, swelling, skin inflammation (dermatitis), tissue necrosis, abdominal and vascular crises, cardiac problems (myocarditis), and shock. Allergic reactions are most commonly caused by bees and include hives (urticaria), swelling beneath the skin (angioedema), breathing difficulties (bronchospasm and laryngeal swelling), and life-threatening anaphylactic shock. Arthropods and insects may be carriers for microorganisms that cause malaria, Lyme disease, tick paralysis, Rocky Mountain spotted fever, West Nile virus or Eastern equine encephalitis.

Reliable statistics are not available for insect bite exposures because most cases are not reported and do not require hospital care. Mortality associated with insect bites is from either anaphylactic reaction or complications resulting from infection.

Hymenoptera stings account for more deaths in the US than any other injection of venom (envenomation). Order Hymenoptera includes Apis (European and African bees), Vespids (wasps, yellow jackets, hornets), and ants.

Outside the US, tarantulas can be found in Mexico, South America, the Caribbean, Africa, the Mediterranean, and Australia. All North American species are relatively harmless, but there are a few species in South America, Africa, and Australia that may be truly dangerous to humans. Funnel web spiders are restricted to the eastern and southern regions of Australia.

Most species of centipedes are small and relatively innocuous. There have been no documented deaths from millipede exposures, and it is unlikely that such an exposure could be fatal, even to small children.

The Centruroides scorpion species are found in the southern US, Mexico, Central America, and the Caribbean. C. exilicauda is found in the southwestern US (primarily Arizona and small parts of Texas, New Mexico, Nevada, and California) and Mexico.

Incidence and Prevalence: Ants sting 9.3 million people yearly. Other Hymenoptera account for more than 1 million stings annually. Estimates of mortality from insect-provoked anaphylaxis in the US range from 50 to 150 individuals annually (Fernandez). Mortality from spider bites occur mostly in very young children and the elderly, and deaths have been attributed to presumed brown recluse envenomation, though this is rare. Accurate, reliable worldwide data on scorpion envenomations do not exist. Many potentially dangerous scorpions inhabit the underdeveloped or developing world. Consequently, numerous envenomations go unreported, and the true incidence is unknown. The highest reported mortality data for scorpion envenomation is from Mexico, with estimates as high as 1,000 deaths in 1 year (Bush).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Older individuals have an increased risk of mortality from insect bites and stings.

Source: Medical Disability Advisor



Diagnosis

History: The initial exposure may not be recognized in all cases. Symptoms usually develop within minutes to an hour and depend on the type of venom injected. After minor insect or spider bites and stings, the reaction is often localized to the site of the insult, with only symptoms of pain, swelling, itching, or burning. Individuals may report nausea, vomiting, diarrhea, cramps, dizziness, anxiety, a red itchy rash, and breathing problems for generalized, more severe reactions.

The venom of the black widow spider causes severe abdominal pain, trunk and abdominal muscle spasm, and diffuse tingling (paresthesias).

A scorpion sting causes pain, itching, tingling, and in severe cases, drowsiness, fainting (syncope), diminished vision, profuse sweating, muscle spasm, and convulsions.

Physical exam: In a generalized reaction or anaphylaxis, the exam may reveal red, elevated patches of skin (urticaria or hives), swelling (angioedema), and blisters. Swelling of the larynx, low or high blood pressure (hypo- or hypertension), rapid heartbeat (tachycardia), irregular heartbeat (arrhythmia) and difficulty breathing (wheezing or dyspnea) may develop.

In a local reaction, the exam may reveal a red raised area, local tissue swelling, drainage at the site of the sting, and a stinger.

There is local tissue destruction and possible necrosis after brown recluse spider bite, or a board-like abdomen after black widow spider bite.

Tests: There are no specific laboratory tests for tarantula, centipede, millipede, insect, or bee/wasp/hornet bites and stings. Laboratory studies may help evaluate organ damage caused by reaction to bee/wasp/hornet stings. A complete blood count (CBC) and blood chemistry may be of benefit as well.

Wound cultures and Gram stain may be of value for local wounds in brown recluse spider bites. If signs of systemic toxicity are present, monitor the individual for evidence of deterioration of red blood cells (hemolysis), kidney (renal) failure, and disorder of blood coagulation (coagulopathy). For possible black widow spider bites with an uncertain diagnosis, laboratory studies to rule out an acute abdomen may be indicated (e.g., CBC, pregnancy test). The serum creatine phosphokinase (CPK) may be elevated.

Scorpion sting cases vary from those requiring no laboratory tests to scenarios requiring extensive hematologic, electrolyte, and respiratory analysis. A complete blood count (CBC), platelets, and coagulation parameters should be obtained as needed. Electrolytes, blood urea nitrogen (BUN), creatinine, and urinalysis may be considered. Renal failure may occur secondary to hemoglobin in the urine (hemoglobinuria) from hemolysis. Creatine phosphokinase (CPK) and urine myoglobin (a red iron-containing protein pigment in muscles that is similar to hemoglobin) may reveal destruction or degeneration of skeletal muscle (rhabdomyolysis) after severe muscle hyperactivity. Arterial blood gases (ABGs) are obtained as indicated for respiratory distress. Obtain an electrocardiogram if indicated.

Source: Medical Disability Advisor



Treatment

Treatment includes gentle removal of a stinger (when present) and application of ice and topical hydrocortisone or oral antihistamines to reduce swelling, pain, and itching for local reactions. Treatment of lice and flea bites includes shampoos and creams containing insecticides. In the case of anaphylactic shock from bee/wasp/hornet or scorpion stings and spider bites, adrenergic receptor stimulators, antihistamines, antivenin, intravenous steroids, and hospitalization may be necessary.

Individuals with a history of hypersensitivity to any of these venoms are advised to carry a dosage of an injectable adrenergic receptor stimulator when there is a risk of exposure to the offending species.

Source: Medical Disability Advisor



Prognosis

The prognosis for a successful recovery is good following treatment for minor insect and spider bites and stings. Most stings resolve with no residual complaints. However, anaphylactic reactions to bee, wasp, or hornet stings can be fatal. Prompt and appropriate treatment will lessen the chances for a fatal outcome.

Severe outcomes from brown recluse spider bites are rare. Typical cases involve only local, soft tissue destruction. Prognosis for recovery from scorpion stings is species dependent. Most individuals recover fully from Centruroides scorpion envenomation.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Allergist/Immunologist
  • Cardiologist, Cardiovascular Physician
  • Dermatologist
  • Emergency Medicine Physician
  • Infectious Disease Internist
  • Internal Medicine Physician
  • Medical Toxicologist
  • Occupational Therapist
  • Pharmacologist
  • Physical Therapist
  • Preventive Medicine Specialist
  • Pulmonologist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Secondary infection may result from insect bites or stings. Symptoms of any disease transmitted by an insect bite may not be evident for days, weeks, or even longer.

Bee, wasp, and hornet sting sites may become infected. Infection is more common in fire ant stings because they frequently are multiple; stings form a fluid filled growth (vesicles) and then ulcerate, leaving itching (pruritic) open wounds. Anaphylaxis may occur in susceptible individuals from exposure to other insect-related material, including honey and treatment involving bee venom in certain diseases and disorders (apitherapy). Myocardial infarction, kidney (renal) failure, and cerebral edema may occur after a bee sting. Peripheral nerve block may occur if sting is near the path of a nerve.

Scorpion stings may result in respiratory arrest, cardiac arrest, shock, seizures, or destruction or degeneration of skeletal muscle (rhabdomyolysis). Death may occur as result of the bite/sting of certain scorpion species found worldwide. Loss of a protein in the blood, hemolysis, or inflammation of the pancreas (pancreatitis) may also result from bites of specific, individual species of scorpions.

Bites of black widow spiders may result in respiratory difficulty with a worsening in the reactive airway. Spontaneous abortion or preterm labor may occur in pregnant women. A high blood pressure (hypertensive) emergency with or without associated seizures and acute myocardial infarction may also occur following the bite of black widow spiders. There may also be destruction or degeneration of skeletal muscle (rhabdomyolysis).

Delayed skin grafting may be necessary after 4 to 6 weeks of standard therapy following the bite of a brown recluse spider. Losses of digits and amputations have been reported. Inflammation of conjunctiva and a round, gray swelling where each hair is embedded (ophthalmia nodosa) and inflammation of the uveal tract (panuveitis) can complicate eye exposure to tarantula hairs. Once the bite of a funnel web spider has been successfully treated with antivenom and the individual has recovered from the acute illness, further complications are unlikely.

Secondary infections and wound necrosis may result from centipede exposures. Conjunctivitis or corneal ulcerations can complicate eye exposures to millipedes.

Source: Medical Disability Advisor



Factors Influencing Duration

Age, physical condition, nutritional status, and general health will influence the individual's response to bites and stings and recovery.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Depending on job requirements, the individual should wear adequate clothing and use chemical repellents as protection from insects and spiders. Those with a history of life-threatening reactions, if in constant contact with insects, may require desensitization and should carry an injectable adrenergic receptor stimulator.

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 a recent history of an insect or spider bite or sting?
  • Does individual complain of local pain, swelling, skin inflammation, tissue necrosis, abdominal and vascular crises, myocarditis, or shock?
  • Does individual have urticaria, angioedema, dizziness, bronchospasm, laryngeal swelling, or life-threatening anaphylactic shock?
  • Does individual have severe abdominal pain, trunk and abdominal muscle spasm, and paresthesias?
  • Does individual have drowsiness, syncope, diminished vision, profuse sweating, muscle spasm, or convulsions?
  • On physical exam, did individual have urticaria or hives, angioedema, blisters, tissue necrosis, a board-like abdomen, swelling of the larynx, hypo- or hypertension, tachycardia, or arrhythmia?
  • Has individual had a CBC, complete chemistry panel, coagulation studies, arterial blood gases if necessary, urine myoglobin, wound culture and ECG?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual had the stinger removed?
  • Is individual being treated with ice, topical hydrocortisone, or oral antihistamines?
  • If necessary, has individual been treated with medicated shampoo?
  • Does individual have anaphylactic shock?
  • Has individual been treated with adrenergic receptor stimulators, antihistamines, or antivenin?
  • Was hospitalization necessary?
  • Does individual have a history of hypersensitivity to any venoms?
  • Does individual carry a dose of an injectable adrenergic receptor stimulator when there is a risk of exposure to the offending species?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Does individual have any complications such as secondary infection, any disease transmitted by an insect bite, or site vesiculation with ulceration?
  • Does individual have anaphylaxis, hypertension, myocardial infarction, renal failure, or cerebral edema?
  • Did a peripheral nerve block occur?
  • If individual was pregnant, did spontaneous abortion or preterm labor occur?
  • Did individual have respiratory arrest, cardiac arrest, shock, seizures, rhabdomyolysis, defibrination, hemolysis, or pancreatitis?
  • Will reconstructive surgery be necessary?

Source: Medical Disability Advisor



References

Cited

Bush, Sean P., and Charles Gerardo. "Scorpion Envenomations." eMedicine. Eds. Robert Norris, et al. 30 Jul. 2003. Medscape. 3 Nov. 2004 <http://emedicine.com/emerg/topic524.htm>.

Fernandez, Miguel C., and Nicolas Arredondo. "Bites, Insects." eMedicine. Eds. Robert M. McNamara, et al. 25 Aug. 2004. Medscape. 3 Nov. 2004 <http://emedicine.com/emerg/topic62.htm>.

General

Norris, Robert. "Millipede Envenomations." eMedicine. Eds. James Li, et al. 15 May. 2006. Medscape. 27 Jun. 2006 <http://emedicine.com/EMERG/topic793.htm>.

Source: Medical Disability Advisor