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.

Puncture Wound


Medical Codes

ICD-9-CM:
870.3 - Penetrating Wound of Orbit, without Mention of Foreign Body
870.4 - Penetrating Wound of Orbit, without Mention of Foreign Body
871.5 - Penetration of Eyeball with Magnetic Foreign Body
871.6 - Penetration of Eyeball with Nonmagnetic Foreign Body
871.7 - Ocular Penetration, Unspecified

Related Terms

  • Animal Bite
  • Gunshot Wound
  • Needlestick Injury
  • Stab Wound

Overview

Puncture wounds are caused by objects that penetrate the skin and underlying tissues and structures. Wounds caused by nails, wires, needles, knives, bullets, and virtually any sharp object are normally punctures. Bites (including dog, cat, and human) are also usually puncture wounds. About 50% of all puncture wounds involve the sole of the foot, and 90% of them are caused by nails (Schroeder). Small puncture wounds usually do not bleed freely, but large puncture wounds may cause severe internal bleeding. The possibility of infection is great in all puncture wounds, especially in deep wounds, bite wounds, and in wounds in which the causative object is contaminated. Perforation is a variation of a puncture wound resulting from a penetrating object entering, passing through, and exiting the body.

Source: Medical Disability Advisor



Diagnosis

History: The individual may give a history of recent injury, and may report pain that is disproportionate to the size of the wound.

Physical exam: The physical exam reveals a hole in the skin. The surrounding skin may be red, warm, swollen, and tender. The individual may have a fever of over 100 degrees F (Blasko). A watery discharge or pus seeping from the wound may be evident. The skin, nerves, tendons, vessels, bones, cartilage, muscles, and fascia of the involved area must be examined for damage. If infection is present, red streaks may be visible on the skin near the wound.

Tests: X-rays of the site may be taken if bone injury is suspected or if foreign objects are deeply embedded. Diagnostic ultrasonography can be helpful in detecting retained foreign objects. Puncture wounds may require an exploratory operation of the abdominal cavity (laparotomy), the chest cavity (thoracotomy), or other involved areas.

Source: Medical Disability Advisor



Treatment

The wound is cleaned. Foreign matter and dead tissue are removed (debrided). The wound is irrigated with saline, antiseptic, or an antibiotic solution. If the puncture wound has penetrated into the joint capsule or bone then surgery may be required, sometimes under x-ray guidance (fluoroscopy) to ensure the removal of all contaminants (Schroeder).

Damage to blood vessels, nerves, or bones often necessitates repair by specialized surgical techniques, such as microsurgery.

If there is obvious contamination, the wound may need to be surgically opened and cleaned. A culture should be taken of the wound, and the appropriate antibiotic prescribed if necessary. The wound is then irrigated with an antiseptic solution, filled with layers of sterile gauze (packed), and covered with a bandage for 4 to 5 days. A surgical drain may be temporarily inserted to permit fluid drainage from the wound. If, after this time, there is no sign of infection, the wound may be left open and allowed to heal on its own.

A tetanus shot (tetanus toxoid, TD) may be given, preferably within 24 hours if it has been over 5 years 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. The tetanus immunization series should be given for those who have never had the “tetanus diptheria” series.

Additional immunizations or prophylactic treatment may be given in certain situations. Animal bites may require antibiotics or rabies immunizations. Antibiotics may also be given with deep or contaminated puncture wounds, or if the individual has diabetes or peripheral vascular disease (Blasko). Puncture wounds contaminated with blood or other human infectious material, such as needle sticks also require additional assessment. Depending on the situation, prophylaxis for hepatitis B, HIV or other bloodborne infections may be indicated.

Source: Medical Disability Advisor



Prognosis

Puncture wounds usually heal with minimal scarring and without any lasting effects. Deep penetrating puncture wounds in the abdomen caused by gunshots result in death in 9.5% to 12.7% of cases; the mortality rate from stab wounds is 3.6% (Testa). After needlestick injuries with exposure to infected blood, the risk of transmission is about 30% for hepatitis B virus, 10% for hepatitis C virus, and 0.3% for HIV.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Emergency Medicine Physician

Source: Medical Disability Advisor



Comorbid Conditions

  • Bleeding disorders
  • Diabetes
  • Immune system disorders
  • Peripheral vascular disease

Source: Medical Disability Advisor



Complications

Approximately 6% to 11% of puncture wounds result in infection of the underlying tissue (Tintinalli), with up to 15% of foot puncture wounds becoming infected (Marx). These infections can take the form of cellulitis, abscess formation, or inflammation of the underlying bone (osteomyelitis). If the puncture wound occurs in the abdominal region, peritonitis or intra-abdominal infection may result.

Source: Medical Disability Advisor



Factors Influencing Duration

Length of disability may be influenced by the severity and depth of the wound, the site of the wound, the method of treatment, or the presence of complications such as infection.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions and accommodations depend on the site of the wound and severity. Personal protection equipment may be required to protect against infection.

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 puncture wound injury been confirmed?
  • Were other types of injuries with similar symptoms, such as incision or laceration wound, ruled out?
  • If bone or joint injury is suspected or foreign objects was deeply embedded, was surgical exploration of the involved area required?
  • Has individual experienced complications such as cellulitis, abscess formation, or osteomyelitis that may affect recovery?
  • If the puncture wound occurred in the abdomen, has individual experienced peritonitis?

Regarding treatment:

  • If there was obvious contamination, did the wound need to be surgically opened and cleaned (debridement)?
  • Did wound repair require specialized surgical techniques (microsurgery) to repair damage to blood vessels, nerves, or bones?
  • Did individual with diabetes or peripheral vascular disease receive antibiotics?
  • If infection occurred, did it respond to antibiotic therapy? Was culture and sensitivity performed to identify the infective organism and determine the most effective antibiotic?
  • Were antibiotic-resistant organisms ruled out?
  • If individual has never been immunized against tetanus, was human tetanus immune globulin given? If it has been over 5 years since the individual's last booster shot, or if there is a question about when the individual was last vaccinated, was a tetanus shot given?

Regarding prognosis:

  • If healing was delayed, what were the extenuating circumstances?
  • If complications occurred, did they respond to treatment?
  • Will further treatment or procedures be required?
  • Does individual have a coexisting condition, such as diabetes, bleeding disorders, or immunosuppression that may complicate treatment or affect recovery?

Source: Medical Disability Advisor



References

Cited

"Nail-gun Injuries Treated in Emergency Departments -- United States, 2001-2005." Morbidity and Mortality Weekly Report 56 14 (2007): 329-332.

Blasko, Barbara J., and Scott E. Rudkin. "Puncture Wound." eMedicine. Eds. Scott H. Plantz, et al. 31 Oct. 2005. Medscape. 22 Sep. 2009 <http://www.emedicinehealth.com/puncture_wound/article_em.htm>.

Marx, J. A., et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis: Mosby, Inc., 2002.

Massaro, T., et al. "Needlestick and Sharps Injuries Among Nursing Students: An Emerging Occupational Risk." G. Ital Med Lav Ergon 29 Suppl 3 (2007): 631-631.

Schroeder, Stephen A., and Peter Blume. "Foot Infections." eMedicine. Eds. John S. Early, et al. 4 Sep. 2009. Medscape. 22 Sep. 2009 <http://emedicine.medscape.com/article/1237208-overview>.

Testa, Paul A., Eric L. Legome, and Lewis J. Kaplan. "Abdominal Trauma, Penetrating." eMedicine. Eds. Roy Alson, et al. 28 Jul. 2008. Medscape. 22 Sep. 2009 <http://emedicine.medscape.com/article/822099-overview>.

Tintinalli, J. E., et al., eds. Emergency Medicine: A Comprehensive Guide. 5th ed. McGraw-Hill, 2000.

Source: Medical Disability Advisor