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.

Toxic Effects, Chlorine


Related Terms

  • Chlorine Gas Poisoning
  • Chlorine Water Poisoning
  • Javelle Water Poisoning
  • Molecular Chlorine Poisoning
  • NAC10 Poisoning

Differential Diagnosis

Specialists

  • Critical Care Internist
  • Medical Toxicologist
  • Ophthalmologist
  • Pharmacologist
  • Preventive Medicine Specialist
  • Pulmonologist

Factors Influencing Duration

Absorbed dose is the primary determinant of severity of toxic effects and therefore the severity and duration of disability. Absorbed dose is dependent on environmental levels, routes of exposure (skin contact, inhalation, ingestion) and duration of exposure.
The levels and length of time exposed, method of exposure, immediacy of treatment, and the individual response to exposure and treatment all affect the length of disability. Age, physical condition, pre-existing disease, and mental attitude have an influence on the individual's ability to recover pre-injury functional capacity. Smokers may have increased disability durations due to pre-existing lung function abnormalities.
Pulmonary function, lung capacity, exercise capacity, and endurance influence the ability to carry out vigorous and demanding work. Visual impairment, both in extent and range, influences the ability to carry out intricate detailed work and perform safely in a work environment.

Medical Codes

ICD-9-CM:
983.9 - Toxic Effect of Corrosive Aromatics, Acids, and Caustic Alkalis, Caustic, Unspecified
987 - Toxic Effect of Other Gases, Fumes, or Vapors
987.6 - Toxic Effects, Chlorine Gas

Overview

Chlorine is a green-yellow gas with an irritating odor. It is used in metal fluxing, in sterilization of water, as a bleaching agent, in the synthesis of chlorinated organic compounds and plastics, and in pulp/paper manufacturing. It is a potent irritant of the eyes, mucous membranes, and skin and also causes pulmonary irritation.

Exposure occurs during inhalation. The location and severity of respiratory tract damage is a function of air concentration and duration of exposure. Death at high exposures results from pulmonary edema.

Populations at special risk from chlorine exposure are individuals with pulmonary disease, breathing problems, bronchitis, or chronic lung conditions.

Incidence and Prevalence: In 2002, 686 people were exposed to chlorine acid and hypochlorite combined, according to the American Association of Poison Control Centers Surveillance System, and 6,661 were exposed to other forms of chlorine. Twenty-one people had a severe reaction to certain kinds of chlorine compounds that left them disabled, and one died from the exposure (Watson).

Source: Medical Disability Advisor



Diagnosis

History: Symptoms may occur immediately or shortly after exposure. The individual may complain of irritation of the eyes, nose, and throat; tearing (lacrimation); coughing; bloody nose; chest pain; or burning of the skin. Pertinent history includes the nature and duration of exposure and any previous lung problems. Patients may experience tender abdomen, weak muscles, headache, nausea, and emesis.

Physical exam: Signs of respiratory distress, such as rapid breathing (tachypnea), bluish skin due to lack of oxygen (cyanosis), difficulty breathing (dyspnea), flaring of the nose, retractions of the chest muscles, wheezing, rales (a sign that fluid is in the lungs), crepitus (heard when there is air in the thoracic cavity), and diminished breath sounds (pulmonary edema) may be present. Symptoms of pulmonary edema can be delayed up to 48 hours after exposure. A rash may be present on the skin. Shock or coma may occur. Patients may also have elevated heart rate, increased hoarseness, and tears.

Tests: Pulmonary function tests, chest x-rays, ECG, ventilation perfusion scan (VQ scan), and arterial blood gases may be performed. Patients may benefit from serum electrolytes, pulse oximetry, and peak flow meters. The patient may need either bronchoscopy or laryngoscopy to help establish the extent of harm done to the airway and lungs.

Source: Medical Disability Advisor



Treatment

The individual is removed from exposure. Symptoms and effects are treated as they occur. The pH of the eye and skin is normally 7.4; the skin may need to be rinsed with saline to achieve the proper pH level. The eye needs to be examined with a slit lamp with fluorescein staining, after which an antibiotic ointment can be applied. Oxygen should be provided, and fluids should be reduced if the individual has acute respiratory distress syndrome. Individuals may also benefit from beta-agonists if they have difficulty breathing. Those with laryngeal spasm need to be intubated and placed on mechanical ventilation.

Source: Medical Disability Advisor



Prognosis

Symptoms may increase in the first 2 to 3 days after exposure, and pulmonary function abnormalities may persist for months. Prolonged symptoms are more likely with pre-existing asthma or other chronic lung disease.

Individuals exposed to high levels of chlorine for an extended period of time may not fully recover. Permanent damage and irreversible effects may occur. Long-term disability may result. Vision may be permanently affected.

When brief, low-level exposure to the eyes has occurred, prompt ophthalmologic treatment by trained personnel with appropriate medications should leave no permanent injury or impairment. Prompt treatment of skin exposure with dermatological medications and fluids should leave no permanent injury or disability.

Exposure to chlorine gas at 430 parts per million (ppm) for over one-half hour is deadly; at 1,000 ppm, death may occur within a few minutes ("Occupational Safety"). Death may result from pneumonia, asphyxia, shock, reflex spasm in the larynx, or massive amounts of fluid in the lungs (pulmonary edema).

Source: Medical Disability Advisor



Rehabilitation

Individuals with respiratory failure or heart disease resulting from the toxic effects of chlorine may require occupational, physical, and respiratory therapy. The exact therapy and frequency depends on the extent and severity of illness.

Respiratory therapy focuses on increasing lung capacity and decreasing the risk for the buildup of lung secretions. Respiratory therapists teach individuals pursed lip breathing to increase the airflow to the lungs. Individuals may also use an incentive spirometer. This device measures and displays the amount of air inspired to help motivate individuals to take deeper breaths. Individuals also learn to produce an effective cough through techniques such as huffing where air is breathed out forcefully while the mouth is open. Individuals also learn positions to relieve shortness of breath such as leaning forward while sitting with the arms resting on the thighs.

Occupational therapy addresses any fatigue or shortness of breath that may occur during activities of daily living. Individuals learn to utilize equipment such as a shower chair to decrease the energy expended during bathing, or a long-handled sponge to decrease the amount of forward bending. Occupational therapists teach energy conservation techniques in which activities of daily living such as meal preparation are broken into smaller components that make tasks more manageable.

Cardiopulmonary physical therapy designs an individualized exercise program that is considered safe for the individual's physical stamina and also addresses decreased endurance, strength, and range of motion. Electrocardiograph (ECG) monitoring of individuals is usually performed during the initial exercise sessions for those with compromised cardiac function. Individuals learn to monitor their pulse and determine the amount of energy they expend by utilizing a rating of perceived exertion scale. This is a numbered scale that rates exercises from "very, very light" to "very, very hard." Individuals use this scale and their pulse to stay within safe exercise parameters predetermined by their physicians.

Individuals perform aerobic exercise such as treadmill walking or stationary bicycling. The aerobic exercise helps the heart muscle improve its efficiency in the use of oxygen, reducing the need for the heart to pump as much blood. This increased fitness level in turn reduces the total workload of the heart. The related increase in endurance allows individuals to return to their prior activity levels.

Individuals learn to stretch the shoulder and chest muscles to promote normal posture, which in turn improves respiration. Individuals perform strengthening exercises of the arms and legs to improve overall endurance. Lying on the back and performing abdominal breathing exercises strengthens the diaphragm. These exercises can be made more difficult by placing weights or a book on the abdomen to provide resistance.

Source: Medical Disability Advisor



Complications

The patient can suffer other pulmonary problems, such as chemical pneumonitis (a lung infection caused by aspirating the toxin), bronchiolitis obliterans, COPD, and reactive airway dysfunction syndrome (RADS), which is asthma caused by irritants such as those one might be exposed to at work.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The Occupational Safety and Health Administration's (OSHA) legal airborne permissible exposure limit (PEL) is 1 ppm of chlorine, not to be exceeded at any time ("Chlorine").

The airborne exposure limit recommended by the National Institute of Occupational Safety and Health (NIOSH) is 0.5 ppm of chlorine that should not be exceeded during any 15-minute work period and 1 ppm of chlorine as a short-term exposure limit (STEL) ("Chlorine").

The American Conference of Governmental Industrial Hygienists (ACGIH) recommends an airborne exposure limit of no more than 0.5 ppm of chlorine averaged over an 8-hour work shift and 1 ppm of chlorine as a STEL ("Chlorine").

The individual must have access to information about the health effects of chlorine gas exposure in the workplace. Respirators, air filters, protective clothing, and eyewear may be needed. Length and levels of chlorine gas exposure in the workplace must be monitored. The individual may need special training to handle the gas.

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:

  • Is or was chlorine present in the exhaled air of exposed individual?
  • Is there a history of chlorine exposure in the workplace?
  • Has individual recently worked in another organization where chlorine exposure is higher?
  • Could chlorine exposure be occurring outside the workplace, i.e., in the home, community, or recreational activities?
  • Does individual have a history of smoking?
  • Is clinical illness, including the history, physical examination, and laboratory findings, consistent with other case descriptions?
  • Is timing between exposure and clinical onset compatible with the known biologic facts about chlorine exposure?
  • Is exposure dose within the range of doses believed to cause such effects?

Regarding treatment:

  • Has individual been completely removed from exposure to chlorine?
  • Does individual require hospitalization?
  • Does individual require treatment by an ophthalmologist for eye damage?
  • Does individual require measures to assist with breathing?
  • Have any complications arisen as a result of the toxicity or of the treatment?

Regarding prognosis:

  • Are there special attributes of the particular individual that make it more or less likely that he or she would be so affected?
  • Are there additional lifestyle or behavioral factors that may potentially contribute to this condition?
  • If there is significant uncertainty about the cause, how important is it to be certain?

Source: Medical Disability Advisor



References

Cited

"Chlorine." Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. 27 Oct. 2004 <http://www.cdc.gov/niosh/nmam/pdfs/6011.pdf>.

"Occupational Safety and Health Guidelines for Chlorine." OSHA. U.S. Department of Labor. 27 Oct. 2004 <http://www.osha.gov/SLTC/healthguidelines/chlorine/recognition.html>.

Watson, William A., et al. "2002 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System." American Journal of Emergency Medicine 21 5 (2003): 353-421. MD Consult. Elsevier, Inc. 2 Jul. 2004 <http://home.mdconsult.com>.

Source: Medical Disability Advisor






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