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.

Pulmonary Edema


Related Terms

  • Cardiogenic Pulmonary Edema
  • Hypostatic Pneumonia
  • Lung Water
  • Noncardiogenic Pulmonary Edema
  • Passive Pneumonia
  • Pulmonary Congestion
  • Wet Lung

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Critical Care Internist
  • Internal Medicine Physician
  • Pulmonologist

Comorbid Conditions

  • Chronic obstructive pulmonary disease (COPD)
  • Emphysema
  • Obesity
  • Underlying cardiac conditions or arrhythmias

Factors Influencing Duration

Length of disability may be influenced by the underlying cause of the edema, the severity of symptoms, method of and response to treatment, the development of complications, and underlying medical conditions.

Medical Codes

ICD-9-CM:
506.1 - Acute Pulmonary Edema due to Fumes and Vapors
514 - Pulmonary Congestion and Hypostasis
518.4 - Edema of Lungs, Acute, Unspecified

Overview

Pulmonary edema is the accumulation of extravascular fluid in the air sacs or air spaces (alveoli) and parenchyma of the lungs. Abnormal (pathologic) fluid accumulation causes the lungs to become stiff and the air sacs of the lungs to become waterlogged. As a result, breathing becomes very difficult. Acute pulmonary edema is one of the most common life-threatening medical emergencies; intervention is needed as soon as the diagnosis is suspected.

Pulmonary edema is not a disease but a serious complication of another disorder, most commonly congestive heart failure or another cardiac condition such as atherosclerotic heart disease. The edema may be called "cardiogenic pulmonary edema" in these instances. The complication arises when the left side of the heart fails to empty completely with each contraction or has difficulty accepting blood returning from the lungs. As a consequence of this failure, the retained blood creates back pressure, blood and tissue fluid back up, and the vasculature of the lungs becomes congested. The pressure abnormalities are complicated and involve several types of pressure (hydrostatic, intracapillary, interstitial, osmotic, intra- and extravascular pressure), which may vary depending upon the underlying diagnosis or cause of pulmonary edema. In pulmonary edema associated with heart disorders, the hydrostatic or intravascular pressure continues to rise until fluid is forced out of vessel walls into the alveoli. The pressure also compromises the ability of the lymph system to maintain fluid balance in the lungs, allowing it to build up faster than it can be removed. Changes in pressure interfere with the exchange of oxygen and carbon dioxide (CO2) in the lungs. When the exchange of air and CO2 is abnormal, the imbalance can quickly lead to hypoxia, respiratory arrest, and death. "Noncardiogenic pulmonary edema" is contingent on an injury to the lung parenchyma or vasculature, and may be secondary to acute lung injury-acute respiratory distress syndrome (ALI- ARDS), lung infections, renal disease, exposure to certain toxins, smoke inhalation, adverse drug reactions, high altitudes, or near drowning.

There are two broad categories of pulmonary edema: increased-pressure pulmonary edema and increased-permeability pulmonary edema. Increased-pressure pulmonary edema is associated with heart disorders such as heart attack (myocardial infarction) and is occasionally the first sign of underlying heart disease. It can also occur as a complication of high blood pressure or following mitral valve replacement, lung and heart bypass surgery, or stroke. Increased permeability pulmonary edema may occur in conjunction with ARDS, bacterial or viral infections, renal failure, near-drowning, head trauma, or as the result of inhaled toxins, vasoactive substances (histamines, kinins), uremia, aspiration and radiation pneumonia, smoke inhalation, subacute bacterial endocarditis, vein stenosis, lymphatic insufficiency, central nervous system (CNS) trauma, eclampsia, and cocaine or heroin abuse. Pulmonary edema can also develop as a complication of improperly performed intubation, or the rapid administration of blood, plasma, serum albumin, intravenous fluids, or intravenous narcotics.

Negative-pressure pulmonary edema (NPPE) can occur in individuals undergoing surgery with intubation. In NPPE, fluid builds up in the lungs as a result of an obstructed airway and negative pressure within the chest (intrathoracic pressure); blood flow also increases to the right side of the heart with increased capillary pressure in the lungs. Individuals with this form of pulmonary edema are generally younger and healthier than those with other forms of pulmonary edema.

High altitude pulmonary edema (HAPE) can occur when otherwise healthy individuals climb energetically and at a good pace to high altitudes to which they are unaccustomed (nonacclimatized). These individuals have elevated pulmonary artery pressures.

Incidence and Prevalence: The prevalence of postoperative NPPE is approximately 0.1%. In patients developing acute postoperative upper airway obstruction, NPPE has been reported at an incidence of up to 11%. About 1 in 1000 patients receiving anesthesia develop negative pressure pulmonary edema and 74% of those occur postextubation (Krodel).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Exposure to inhaled toxins, aspirated toxins, vasoactive substances (histamines, kinins), dense smoke, and the abuse of certain drugs such as cocaine or heroin may increase an individual's risk of pulmonary edema. Young healthy, athletic males may be at increased risk for negative-pressure pulmonary edema (Krodel; Restrepo).

Cardiac disorders and bacterial or viral infections affecting the lungs are known to increase the risk for pulmonary edema.

Source: Medical Disability Advisor



Diagnosis

History: The clinical signs and symptoms can start as a primary manifestation of a certain condition or as evolution of an existing condition. Symptoms will likely include difficulty breathing or shortness of breath (dyspnea), rapid breathing (tachypnea), anxiety, restlessness, excessive sweating, and coughing up pink, frothy sputum. The individual may report feeling as if they are "drowning" or that they cannot get enough air.

Physical exam: Physical findings include cold extremities either with or without a pale complexion, engorged neck veins, rapid heartbeat (tachycardia), elevated blood pressure (hypertension), wheezing, and/or swelling (edema) in the hands and feet. Nasal flaring may also be seen along with the extensive use of accessory muscles just to breathe, temporary episodes of no breathing (apnea), and profuse sweating (diaphoresis). Listening to the chest with a stethoscope (auscultation) may reveal crackles in the lungs (moist rales) with or without wheezing, and abnormal heart sounds.

Tests: A standard chest x-ray is considered the quickest method of differential diagnosis and the most sensitive method confirming a diagnosis of pulmonary edema. Color-flow Doppler echocardiogram (using ultrasound to detect structural or functional abnormalities of the heart), and heart catheterization may also be used to aid in diagnosing pulmonary edema. Other tests that will typically be done include a complete blood count (CBC) with differential white blood cells count, blood urea nitrogen (BUN), creatinine, and serum protein concentrates; a routine urinalysis (UA); and arterial blood gases (ABGs). Usually ABGs will reveal a low oxygen concentration and high carbon dioxide concentration in individuals with suspected pulmonary edema. Electrocardiogram (ECG) monitoring may be used for diagnosis and follow-up purposes.

Source: Medical Disability Advisor



Treatment

Because it is a medical emergency, individuals will require immediate hospitalization for life-support interventions and emergency treatment. Oxygen therapy will be delivered immediately by mask or tube through the nose into the trachea (endotracheal tube [ETT]) with mechanical ventilation to ensure sufficient oxygenation of the individual's circulatory system [airway assistance]. The person may be instructed to sit up in bed with their legs dangling to make respiration easier and decrease venous return. A brief history, physical exam, and laboratory tests will be done to establish the underlying cause of the pulmonary edema, so that it can be treated with specific measures. These may include heart-regulating drugs, fast-acting intravenous diuretics to eliminate excess body fluid, morphine to relieve anxiety and pain, and blood pressure medications. The individual must be continuously monitored until the condition returns to normal. Post-hospitalization measures to prevent or reduce cardiopulmonary symptoms may include a low-sodium diet, regular exercise, avoiding smoking, and regular follow-up exams to monitor progress.

Source: Medical Disability Advisor



Prognosis

The outcome of pulmonary edema depends largely on the underlying cause. Untreated, pulmonary edema can lead to respiratory arrest and death. Pulmonary edema that is not heart related (non-cardiogenic) generally responds well to treatment, while cardiogenic pulmonary edema has a variable mortality rate.

Source: Medical Disability Advisor



Complications

Possible complications of pulmonary edema include acute heart attack (myocardial infarction [MI]), cardiogenic shock, arrhythmias, electrolyte disturbances, mesenteric insufficiency, protein enteropathy, respiratory arrest, and death.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

An underlying heart condition may necessitate changing job duties to those with less physically demanding or emotionally stressful responsibilities. Because pulmonary edema can be an occupational hazard of exposure to chemical gases (e.g., phosgene), individuals should take precautions that include working in well-ventilated areas, wearing masks, reading hazardous material warnings, and following the Occupational Safety and Health Administration (OSHA) guidelines for handling and working with hazardous materials.

For more information on risk, refer to "Work Ability and Return to Work," pages 271, 274.

Risk: Risk, Capacity and Tolerance reflect the underlying cause, by far most commonly heart failure.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 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:

  • Does individual's history contain risk factors for of development of pulmonary edema, such as heart failure, recent heart attack, heart surgery, valvular heart disease, renal failure?
  • Did individual have the characteristic symptoms of pulmonary edema, such as tachypnea, dyspnea, anxiety, restlessness, excessive sweating, and coughing up pink, frothy sputum?
  • Did a chest x-ray and/or pulmonary artery pressure measurements confirm the diagnosis of pulmonary edema?
  • Was individual exposed to a high-altitude atmospheric pressure?
  • Was individual exposed to any worksite chemical known to be associated with pulmonary edema?

Regarding treatment:

  • Did individual receive immediate life-support interventions (ECG monitoring, airway assistance, oxygenation, ventilation)?
  • Were appropriate medications administered (e.g. diuretics, morphine)?
  • Did individual receive ongoing intensive care and monitoring?
  • Was the underlying cause of the condition detected and addressed in the treatment plan?

Regarding prognosis:

  • Based on individual's age, general health and underlying cause of the pulmonary edema, what was the expected outcome?
  • Does individual have any underlying conditions (e.g., heart failure, kidney failure, chronic lung disease) that may affect recovery and prognosis? If so, is are conditions being addressed in the treatment plan? Has individual received consultation from appropriate specialists (cardiologist, pulmonologist, nephrologist)?
  • Did individual experience any complications that could delay recovery or impact prognosis (cardiac arrest, etc.)?

Source: Medical Disability Advisor



References

Cited

Krodel, D. J., et al. "Case Scenario: Acute Postoperative Negative Pressure Pulmonary Edema." Anesthesiology 113 (2010): 200-207.

Restrepo, C. S., et al. "Pulmonary Complications from Cocaine and Cocaine-Based Substances: Imaging Manifestations." Radiographics 27 (2007): 941-956.

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.

Source: Medical Disability Advisor






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