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.

Open Wound, Back


Specialists

  • Emergency Medicine Physician
  • Family Physician
  • General Surgeon
  • Internal Medicine Physician
  • Neurosurgeon
  • Occupational Therapist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Pulmonologist

Comorbid Conditions

Factors Influencing Duration

The age of the individual; extent and location of injury; presence of complications; nature of internal injuries, if any; and response to treatment may influence disability.

Medical Codes

ICD-9-CM:
876.0 - Open Wound, Back without Mention of Complication
876.1 - Open Wound, Back, Complicated

Overview

An open wound to the back refers to any break in the skin of the back. The back includes any area from the shoulders down to the pelvis. Wounds are classified as open wounds if the protective skin layer is damaged and exposes underlying tissue to the outside air.

An open wound can cause serious internal and external bleeding. In addition, since the protection of the skin has been penetrated, the wound is easily contaminated and may become infected.

The majority of open wounds to the back are stab wounds from assaults (knife wounds) or from being accidentally impaled by a sharp object. Other causes of open wounds to the back include gunshot wounds, direct trauma such as falls, vehicle accidents, or exposure to extreme heat or cold (burns or frostbite).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals in occupations such as construction, law enforcement, or the military may be at greater risk of sustaining open wounds to the back.

Young adult males are at greatest risk for open back wounds.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report direct trauma to the back area coupled with a history of bleeding from the site. If conscious, individual may complain of chest pain, shortness of breath, or dizziness.

Some individuals may have exposed the wound to dirt or other contaminants such as manure or rust. Information may be ascertained as to how much time elapsed between receiving the wound and getting medical attention. They may report pre-existing conditions that could affect wound healing, such as smoking, diabetes, vascular disease, or use of certain medications. The date of the last tetanus injection is helpful.

Physical exam: Since open wounds to the back may be associated with significant blood loss or severe, life-threatening injuries to the lung or spinal cord, diagnostic workup and treatment is usually done simultaneously. A sharp object may be protruding from the wound. There may be signs of shock such as low blood pressure (hypotension), cool skin, and rapid pulse. Breathing may be labored and noisy or absent. The trachea may be deviated to one side because of a collapsed lung (pneumothorax). Respirations may be rapid (tachypnea), and the skin may appear blue (cyanosis). If the wound has penetrated the spinal cord, the individual may display loss of sensation or motor function below the level of the wound. Other findings can include blood pooled beneath the skin (hematoma).

Tests: Arterial blood gases or pulse oximetry determines adequacy of oxygenation. Hemoglobin and hematocrit levels are checked for evidence of significant blood loss. A chest x-ray determines the extent of the injury. A CT of the upper torso shows if the wound extends into the chest cavity or spinal cord. Magnetic resonance imaging (MRI) may be useful in evaluating soft tissue injuries, foreign bodies, and hematomas. An electrocardiogram (ECG) may be done to detect heart rhythm disturbances.

Source: Medical Disability Advisor



Treatment

Treatment consists of prompt control of bleeding and thorough repair of injured tissue in order to minimize risk of infection and loss of function.

Applying pressure with a sterile dressing usually controls the bleeding. Intravenous fluids may be given to treat any symptoms of shock. If the lung is penetrated, a tube is placed in the chest (thoracostomy) to drain blood (hemothorax) or expand a collapsed lung (pneumothorax). Extensive wounds such as burns or blast-type wounds from explosions or guns may require surgical wound exploration and removal of foreign bodies, bone fragments, and unhealthy or dead (necrotic) tissue (débridement). Wounds that damage the vertebrae and / or spinal cord may require surgical stabilization of any vertebral fractures (spinal fusion) or the placement of a vest (body brace or Jewett brace) to stabilize the fracture.

Less extensive wounds to the back such as abrasions, lacerations, and puncture wounds are treated by using scissors to clip the hair surrounding the wound, cleaning the wound with saline or mild antiseptic solution using a high-pressure irrigating device (syringe or water pik), removing any remaining foreign matter, and trimming the ragged or unhealthy tissue with sterile scissors or a scalpel. Most wounds are then closed using stitches, surgical tape (Steri-Strips), staples, or a combination.

Wounds with a high-risk of infection (puncture wounds, human and animal bites) or wounds 12 to 24 hours old are left open and then closed with stitches, if needed, in 5 to 7 days (delayed primary closure). In larger wounds which are more than 24 hours old, the area is cleansed, débrided and then packed with wet to dry dressings. The wound is then either allowed to heal naturally, allowing scar formation, or it may be closed surgically in 5 to 7 days.

The repaired wounds are covered with an antibiotic ointment and appropriate bandage. A tetanus shot (tetanus toxoid) may be given if over 10 years has passed since the individual's last booster shot, or if there is a question about when the individual was last vaccinated. If the individual has never been immunized against tetanus, human tetanus immune globulin may be given.

Source: Medical Disability Advisor



Prognosis

The outcome of an open wound to the back varies according to the extent and severity of the injury, the damage to internal organs or the spinal cord, and the promptness of emergency intervention. Superficial back wounds are rarely associated with serious complications and generally have a good outcome. Even those wounds that penetrate deeply and cause lung injury have an excellent outcome with prompt emergency treatment and thoracostomy, as appropriate. If the wound penetrates and damages the spinal cord, there may be partial or complete loss of sensation or motor function (partial paralysis or hemiplegia) below the level of the injury, resulting in permanent disability.

Source: Medical Disability Advisor



Complications

Complications associated with open wounds to the back may include infection, cellulitis, deformity, overgrowth of scar tissue (keloid formation), gangrene, bleeding (wound hemorrhage), hemorrhagic shock, overwhelming systemic infection (sepsis), and tetanus, a potentially fatal infection of the nervous system.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations vary according to the location and extent of the injury sustained from the wound. Individuals with wounds that penetrate only the skin surface should avoid conditions that expose the wound to moisture, pressure, or contamination. Individuals with wounds that extend into the lungs may need modified duty and should avoid heavy lifting until the wound heals. Those with spinal cord involvement need work accommodations according to the degree of physical disability. The individual's physician and therapists can provide exact specifications regarding restrictions and accommodations in these cases.

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 serious internal and external bleeding?
  • Has the wound become contaminated?
  • What was the cause of individual's wound? Stabbing, gunshot, fall, vehicle accident, burn, or frostbite?
  • Was individual conscious?
  • Did individual have any chest pain, shortness of breath, or dizziness?
  • How much time elapsed between receiving the wound and getting medical attention?
  • When did individual last have a tetanus booster?
  • Does individual smoke, have diabetes or vascular disease, or take medications that might delay healing? Does individual display signs of shock?
  • Were other parts of the body also injured? To what extent?
  • Does individual have loss of sensation or motor function below the level of the wound?
  • Were appropriate diagnostic tests done, such as complete blood count, chest x-ray, CT, and ECG?

Regarding treatment:

  • Did individual receive appropriate and timely treatment for all the injuries?
  • Was bleeding stopped with application of direct pressure?
  • Was the wound explored to determine the extent of injury?
  • Was the wound thoroughly cleaned and then débrided if necessary?
  • Did the wound extend into the chest cavity or spinal cord?
  • Did individual have an abrasion, laceration, or puncture?
  • How was the wound closed?

Regarding prognosis:

  • Does individual have any conditions such as diabetes, bleeding disorders, immune system disorders, peripheral vascular disease, and malnutrition that may affect ability to recover and further lengthen disability?
  • Did any complications arise, such as infection, or hemorrhagic shock?

Source: Medical Disability Advisor



References

General

Clochesy, John M., et al., eds. Critical Care Nursing. 2nd ed. Philadelphia: W.B. Saunders, 1996.

Source: Medical Disability Advisor






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