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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.

Syncope


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

Related Terms

  • Blackout
  • Fainting
  • Transient Loss of Consciousness

Overview

Syncope, or fainting, is a temporary loss of consciousness due to inadequate blood flow to the brain.

There are many causes for syncope, including fatigue, pain, dehydration, prolonged or excessive heat exposure (heat exhaustion), low blood sugar (hypoglycemia), diabetes, Parkinson's disease, anemia, emotional disturbances, hyperventilation, exertion, or being in a poorly ventilated room without adequate oxygen. Syncope can be caused by standing still for a long time or by standing up suddenly after sitting or lying down for a long time (postural or orthostatic syncope). This happens because the blood has pooled in the leg veins, reducing the amount available for the heart to pump to the brain. The resultant drop in blood pressure (postural hypotension) is common in the elderly, in diabetics, and in individuals who take certain cardiac medication (antihypertensive or vasodilator).

Feeling faint, or fainting, is a common occurrence during pregnancy, when muscles surrounding the blood vessels relax, often lowering the blood pressure.

Another common cause of syncope is overstimulation of the vagus nerve (vasovagal attack). The vagus nerve helps to control breathing and blood circulation. Overstimulation may occur because of severe pain, stress, fear, prolonged coughing, straining to urinate or defecate, or blowing into a wind instrument.

Serious heart disease, such as blood clots in the valves or a heart tumor, can obstruct blood flow in the heart, causing syncope. Another cause of syncope is irregular heartbeat (arrhythmia).

Vertebrobasilar insufficiency is a disorder that can temporarily obstruct the blood flowing through the neck to the brain, causing a transient ischemic attack. Syncope can also be caused by a blocked or burst blood vessel (stroke). Pressure on blood vessels caused by osteoarthritis of the bones in the neck can cause a feeling of faintness when the head is suddenly turned.

Syncope can be a symptom of Stokes-Adams syndrome. In this disorder, blood flow to the brain becomes temporarily inadequate due to an irregular heartbeat (arrhythmia). Interruption of the electrical impulses in the heart (heart block) usually causes the irregular heartbeat.

Syncope is a major cause of morbidity and mortality in older individuals.

Incidence and Prevalence: Syncope is a common condition, accounting for 3% of emergency department visits and up to 6% of admissions each year in the US. The Framingham study showed that over a 26-year period, approximately 3% of the US population had one syncopal episode. Thirty percent of these patients will experience another syncopal episode (Morag).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Pregnant women, workers in hot and enclosed places, workers who stand on their feet all the time, and performers are also at higher risk for syncope. The elderly are at increased risk for syncopal episodes (Morag).

Source: Medical Disability Advisor



Diagnosis

History: The individual may report symptoms such as nausea, sweaty palms, rapid heart rate, dizziness, feeling of extreme weakness, and loss of color in the face before abrupt loss of consciousness. Other symptoms may suggest specific causes. Factors bringing on the fainting spell may include fear or other strong emotion, fatigue, sleep or food deprivation, a hot environment, or pain. It is important to determine what the individual was doing before the fainting spell, as syncope at rest, with activity, or in specific situations such as shaving or coughing may suggest different causes. Whether the individual was standing, sitting, or lying down when fainting also helps determine the specific cause. Witnesses to the syncope should report that the loss of consciousness lasted for only a few minutes, with rapid return to full level of consciousness, and without jerking movements during the episode or confusion after the episode that would suggest seizure activity. Medications, medical history, and family history may all contain important clues as to the specific cause of syncope.

Physical exam: Individuals may present with sweaty palms, rapid heart rate, and pale skin. Fever may suggest a precipitating cause, such as urinary infection or pneumonia. Drop in blood pressure and rise in pulse when the individual stands up suggests syncope related to postural changes (postural or orthostatic syncope). Rapid or slow pulse may suggest heart problems causing syncope. The individual should be examined carefully for trauma sustained during the fainting spell. Careful examination of the heart, lungs, and blood vessels may detect abnormalities causing syncope. A neurological examination should be normal; abnormalities may suggest transient ischemic attack or seizure rather than syncope. Specific maneuvers (such as the Hall-Pike maneuver or carotid sinus massage) may detect specific causes.

Tests: Blood tests should include serum electrolytes, blood glucose to rule out low blood sugar (hypoglycemia) and blood count to rule out anemia, although stool guaiac examination is more likely to reveal gastrointestinal bleeding causing fainting. Creatine kinase (CK) can be increased if the cause of syncope is seizure. Urinalysis and chest x-ray should be done to rule out urinary infection or pneumonia. Cardiac electrophysiology testing, such as ECG, exercise stress test, Holter monitor, and echocardiogram are done to rule out any heart abnormalities. Ventilation-perfusion scan should be done if pulmonary embolus is suspected. Head-up tilt table test may be necessary to determine cardiovascular reflexes. Brain CT, chest or abdominal CT, and brain MRI are rarely indicated. Electroencephalogram (EEG) should be done if seizure is suspected.

Source: Medical Disability Advisor



Treatment

Recovery from syncope occurs as soon as normal blood flow is restored to the brain. The individual should be lying down with the legs elevated for 10 to 15 minutes after regaining consciousness to prevent another attack.

If the individual does not regain consciousness within a minute or 2, medical help should be obtained promptly. Emergency care should include protection of the airway and of circulation, and intravenous medications or oxygen may be needed.

Recurrent syncope needs to be evaluated to rule out a more serious underlying condition. Individuals who have had episodes of syncope in the past should be instructed to watch for the warning signs of fainting, such as lightheadedness, dizziness, and nausea. When they experience these warning signs, they should lie down or put their heads between their knees. They should also be careful not to get up suddenly or to remain standing for long periods of time and should avoid situations or activities that tend to bring on their syncopal attacks.

Syncope originating in the heart may require treatment with anti-arrhythmic drugs, beta-blockers, or a pacemaker. Syncope related to disease of the heart valves may require valve replacement.

If the individual has orthostatic syncope, the head of the bed should be raised; the individual may also benefit from compression stockings (thrombo-embolism deterrent [TED] hose), steroids and alpha-1 antagonist. Neurologic syncope is treated the same as orthostatic syncope. If the individual has situational syncope, hydration is important, but later in the course of their illness, they may need a pacemaker.

Source: Medical Disability Advisor



Prognosis

An episode of syncope may be life-threatening if not treated properly. It usually ends with a return to complete consciousness within minutes to hours. Since syncope may be a symptom of an underlying condition, the outcome will depend on the specific diagnosis. Simple fainting (vasovagal syncope) has an excellent outcome, and recurrences are rare. Syncope related to changes in position (postural and orthostatic syncope) and syncope occurring in specific situations, such as shaving or coughing (situational syncope), also have excellent outcomes but are more likely to recur, may interfere with quality of life, and may predispose individuals to secondary injury. Syncope related to heart conditions has a poor outcome, with up to 18% to 33% of individuals dying in 1 year (Morag). These individuals are usually significantly restricted in daily activities but may do better after surgery or pacemaker placement. In a study performed 1 year after the syncopal episode on patients who did not know what caused their syncope, 2% had an unexpected demise, 20% of patients had syncope that kept coming back, and 78% had no recurrence (Morag). Remission is common with syncope.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Because its onset is usually abrupt, injuries due to falling are a frequent complication. If the individuals do not regain consciousness in a short time, they may develop a seizure. This is especially likely if those around them try to help them to a standing position too quickly.

Source: Medical Disability Advisor



Factors Influencing Duration

If syncope is due to an underlying cause, the specific diagnosis may influence the length of disability. An individual's job requirements may also determine the length or degree of disability. Age and mental health of the individual may also influence the length of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Safety considerations may affect whether an individual can perform his or her usual duties if experiencing episodes of syncope. Job duties that require working at heights or in hot, stuffy environments, working with heavy equipment or motor vehicles, standing for long periods, or engaging in hazardous activities may have to be restricted or modified. Depending on the underlying cause of syncope, more modifications or restriction may be necessary.

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 diagnosis of syncope been confirmed and other conditions, such as seizure, hypoglycemia, adrenal insufficiency, hyponatremia, drug reaction, alcohol intoxication, subarachnoid hemorrhage, stroke, hyperventilation syndrome, narcolepsy, and panic attacks, ruled out?
  • Has the cause of syncope been identified?
  • Does individual have an underlying condition that may affect recovery?

Regarding treatment:

  • Has the cause of syncope been positively identified?
  • Is more diagnostic testing or evaluation warranted?
  • Is the underlying condition responding to treatment?

Regarding prognosis:

  • If underlying condition is not responding to treatment, would individual benefit from consultation with a specialist (cardiologist, neurologist, hematologist, internist, endocrinologist)?
  • How often do syncope episodes occur?
  • To what extent do they affect functioning?
  • Is individual at risk for secondary injury due to job duties that require working at heights, in hot, stuffy environments, working with heavy equipment or motor vehicles, or standing for long periods?

Source: Medical Disability Advisor