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.

Trauma

trauma in русский (Россия)

Related Terms

  • Injury

Differential Diagnosis

Specialists

  • Emergency Medicine Physician
  • Gynecologist
  • Internal Medicine Physician
  • Nephrologist
  • Neurosurgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Plastic Surgeon
  • Pulmonologist
  • Thoracic Surgeon
  • Urologist
  • Vascular Surgeon

Comorbid Conditions

Factors Influencing Duration

Factors influencing the length of disability include the general health and age of the individual, the severity and location of the injury, the presence of complications, access to rehabilitation facilities if needed, and the strength of the individual's support system.

Medical Codes

ICD-9-CM:
958 - Certain Early Trauma Complications
958.4 - Trauma Complications; Early; Traumatic Shock
959 - Injury, Other and Unspecified
959.0 - Injury of Head, Face, and Neck, Other and Unspecified
959.01 - Head Injury, Unspecified
959.09 - Injury of Face and Neck
959.1 - Injury, Other and Unspecified; Trunk
959.2 - Injury, Other and Unspecified; Shoulder and upper arm; Axilla; Scapular region
959.3 - Injury, Other and Unspecified; Elbow, Forearm, and Wrist
959.4 - Injury, Other and Unspecified; Hand, Except Finger
959.5 - Injury, Other and Unspecified; Finger; Fingernail; Thumb (Nail)
959.6 - Injury, Other and Unspecified, Hip and Thigh
959.7 - Injury, Other and Unspecified; Knee, Leg, Ankle, and Foot
959.8 - Injury, Other and Unspecified, Other Specified Sites, Including Multiple
959.9 - Trauma, Other and Unspecified, Unspecified Site

Overview

Trauma is an injury to the body that occurs when a physical force contacts the body. The trauma may be blunt or penetrating. Examples of blunt trauma are motor vehicle collisions, falls, and assaults with a blunt object. Examples of penetrating trauma include gunshot wounds and stab wounds. Thermal trauma occurs in fires, electrical injuries, and hypothermia and frostbite. Exposure to these forces can cause soft tissue injuries, fractures, bleeding, and tearing of vital organs and blood vessels, all of which can result in severe disability and death.

The severity of the injury is related to the force of the impact, duration of impact, body part involved, injuring agent (blast, blunt object, penetrating object), and any associated risk factors (age and preexisting medical conditions). Trauma from falls from heights and high-velocity collisions often result in injury to more than one body part (multiple trauma). Trauma most often results from motor vehicle collisions, burns, falls, gunfire, or assaults with blunt or penetrating objects.

Incidence and Prevalence: Trauma results in 179,065 individuals losing their lives every year (“All Injury”). In 2005, motor vehicle accidents resulted in 43,667 deaths, with firearm fatalities not far behind at 30,694 deaths (Fingerhut). In 2006, another 21,647 deaths were attributed to falls (“Fall Deaths”).

The incidence of nonfatal traumatic injuries in 2008 was 9,909 per 100,000 people (“Overall”). The incidence of fatal traumatic injuries in 2006 was 60.02 per 100,000 people (“All Injury”). The incidence of fatalities related to falls in 2006 was 7.26 per 100,000 people (“Fall Deaths”).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Every 5 minutes there is a death from a traumatic injury ("Accidental Deaths"). Traumatic accidents are the leading cause of death for those between the ages of 1 and 41, and the fifth leading cause of death overall after heart disease, cancer, stroke, and chronic lower respiratory diseases ("Accidental Deaths").

The leading cause of traumatic injury is motor vehicle accidents (MVAs), with the most at-risk individuals being those who drive too fast, do not use seatbelts, or drive distracted or under the influence of alcohol and/or other drugs ("Accidental Deaths"). Individuals with the highest risk for death from MVA or firearm accident, the second-leading cause of traumatic injury, are those between the ages of 20 and 24; elderly individuals over the age of 85 are also at higher risk of dying in an MVA (Fingerhut).

Since 1992, traumatic injuries leading to death at home and in the community have increased by 30%, while work-related traumatic deaths have decreased by 17% and deaths from MVA have decreased 16% ("Accidental Deaths"). At home, the leading cause of death from traumatic injury is falls (12,800 individuals). Overall, nonfatal traumatic accidents were responsible for 24 million injuries in 2005 ("Accidental Deaths").

Because trauma is a disease of the young and carries the potential for permanent disability, it is responsible for significant loss in productive work years. Job-related injuries in 2004 accounted for 3.7 million American workers being disabled and 5,000 dying ("American Workers"), but nearly twice that number suffered disabling injuries away from the job site ("American Workers"). In economic terms, it is estimated that the cost of fatal and nonfatal traumatic injuries is $625.5 billion, equivalent to approximately $5,500 for each family ("Accidental Deaths").

Source: Medical Disability Advisor



Diagnosis

History: The victim or witnesses report trauma to local ambulance, fire, police, or emergency room personnel. The individual or witnesses may report circumstances of the injury that are helpful in the diagnosis, including injury mechanism (fall, gunshot, motor vehicle accident), speed of impact, amount of damage to the vehicles, use of restraints (seatbelts) or helmet, length of the fall, position or condition of the victim at the scene, evidence of blood loss, and any known medical alert information about the individual (i.e., recent or chronic illnesses or history of drug or alcohol use).

Physical exam: The physical assessment of a trauma victim is composed of a primary survey to look for life-threatening injury, followed by a secondary survey. In the primary survey, evidence of airway or breathing problems, such as pale or bluish complexion, noisy breathing, shallow or slow respirations, foreign objects, and sucking chest wounds, may be found. There may be evidence of neurological impairment such as decreased level of consciousness. Hypotension or shock may be present, and pulse may be rapid or weak. Individuals may present with areas of tenderness, bone deformity, bruising, and lacerations.

Tests: X-rays and computed tomography (CT) are done as needed. The routine procedure for blunt trauma is to obtain portable radiographs of the cervical spine, chest, and pelvis. Three studies are used to evaluate blunt abdominal or chest trauma: diagnostic peritoneal lavage (DPL), CT scanning, and ultrasonography (US). Management of penetrating abdominal trauma differs from that caused by blunt injury. All gunshot wounds that penetrate the abdomen require surgical exploration (laparotomy) because of the high incidence of significant injury. The surgical exploration serves as a tool for diagnosis as well as treatment of injuries. Urinalysis, complete blood count (CBC), and blood typing and cross-matching may be performed; glucose, urea, ammonia, electrolytes, alcohol, blood urea nitrogen (BUN), creatinine, liver profile, and arterial blood gases may be measured. A spinal tap and tests on cerebral spinal fluid may be done.

Source: Medical Disability Advisor



Treatment

Trauma assessment and intervention typically occur simultaneously and begin at the scene of the accident; these steps usually are begun by an emergency medical technician (EMT), a registered nurse (RN), or a paramedic. Immediate attention is directed to managing life-threatening conditions such as obstructed airway, lack of breathing, cessation of heartbeat, or severe bleeding. Assessment of the need for simple first aid, splinting, and protection of the individual to prevent further injury is then appropriate. Immediate transport to a medical facility with trauma capabilities is the final priority.

Initial care at the trauma center assesses and responds to the need for resuscitation. If airway, breathing, or level of consciousness is inadequate, an artificial airway is inserted (intubation). Supplemental oxygen is given. Treatment of immediate life-threatening injury of the chest and abdomen, such as cardiac tamponade, tension pneumothorax, open pneumothorax, flail chest, massive hemothorax, and blunt or penetrating abdominal wound injuries, is done. An intravenous drip administers replacement fluids or blood (transfusion) as indicated. Blankets, warming lights, or warm intravenous fluids keep the individual warm and decrease the risk of hypothermia.

Any fractures with lack of blood supply to the area are treated at this time. Injuries of the hand, neck, and spinal cord are addressed. Tetanus protection is given if needed. Any closed fractures or skin injuries are treated last. The individual is then taken to surgery or the intensive care unit (ICU) as appropriate.

Source: Medical Disability Advisor



Prognosis

The outcome from trauma varies according to the nature and severity of the injury and the promptness of medical attention. In general, better outcomes are reported when trauma injuries are managed within 1 hour in a comprehensive trauma center. Individuals at highest risk for death from multiple traumatic injuries are those with the triad of low body temperature (hypothermia), decreased blood circulation with increased lactic acid production (metabolic acidosis), and inability of the blood to clot normally (coagulopathy) (McArthur).

Death due to trauma occurs in one of three time periods. Immediate death occurs within seconds or minutes of the initial injury, and results from tearing in the brain, brain stem, spinal cord, heart, aorta, or other large vessels. Early death occurs within hours of the injury and results from airway problems, blood clots in the brain (subdural or epidural hematomas), blood or air in the chest cavity (hemothorax or pneumothorax), or other injuries associated with significant blood loss such as lacerations of the spleen or liver or pelvic fractures. Finally, late death from trauma results from complications of infection, multiple organ failure, or severe brain injury.

Overall, the death rate for blunt chest injuries is 1%; for chest injury that includes more than 2 rib fractures, 4.7%; and for flail chest, 17% (Liman). With multiple traumatic injuries, 50% of individuals die from blood loss (hemorrhage) (McArthur). Individuals with a multiple trauma combination of pelvic, abdominal, vascular, and organ injuries have a death rate of nearly 100% (McArthur).

Source: Medical Disability Advisor



Complications

Complications of trauma may include airway obstruction, shock from severe blood loss, sepsis, organ failure, and death.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions and accommodations depend on the injuries sustained.

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:

  • Did individual present with a history of some sort of traumatic event (i.e., vehicle accident, fall, altercation)?
  • Was trauma from a blunt force or fall?
  • Did individual present with any obvious tissue injury or deformity?
  • Did individual sustain blunt trauma to the head, chest, abdomen, or pelvis? If so, did individual display any symptoms suggestive of injury to the underlying organs (change in level of consciousness or shock symptoms)?
  • Was a thorough physical exam and diagnostic workup done by a specialist in trauma care?
  • Were spinal x-rays done to rule out fractures or dislocations?
  • Was spinal tap necessary?
  • Was there evidence of internal bleeding detected with a hemoglobin and hematocrit level?
  • Was a CT done of the areas of injury to look for injury to underlying structures?
  • Was diagnostic peritoneal lavage done? Ultrasonography?
  • If gunshot wound was present, did individual have exploratory surgery?
  • Were all injuries immediately recognized (in the emergency room or trauma center), or were some injuries not discovered until later in the hospital stay?
  • If the diagnosis of trauma was uncertain, were other conditions considered in the differential diagnosis?

Regarding treatment:

  • Was care rendered by emergency personnel (EMT, RN, paramedic) at the scene of the accident?
  • Did individual receive immediate control of life-threatening injuries?
  • Was individual treated promptly in an emergency department or trauma center?
  • Was individual stabilized?
  • Did individual need blood transfusion(s)?
  • Did individual require urgent surgical intervention?
  • Is individual receiving appropriate physical, occupational, and behavioral rehabilitation therapy?

Regarding prognosis:

  • Did individual have a severe injury? Multiple injuries?
  • Based on the extent and severity of injuries, what was the expected outcome?
  • Did individual receive prompt medical attention by a facility that specializes in trauma care?
  • Does individual have any comorbid conditions that may affect the ability to recover?
  • Did individual suffer any complications that may have affected the length of disability?

Source: Medical Disability Advisor



References

Cited

"Accidental Deaths Increasing at Alarming Rate; Poisonings, Overdoses Seeing Greatest Gains. One Person Killed by an Accident Every Five Minutes." National Safety Council. 7 Jun. 2007. 15 Oct. 2009 <http://www.nsc.org/Pages/AccidentalDeathsIncreasingatAlarmingRate.aspx>.

"All Injury Deaths and Rates per 100,000." National Center for Injury Prevention and Control. 2006. Centers for Disease Control and Prevention. 8 Dec. 2009 <http://www.cdc.gov/injury/wisqars/index.html>.

"American Workers' Safety Concerns Don’t Reflect Reality." National Safety Council. 1 Jun. 2006. 8 Dec. 2009 <http://www.nsc.org/Pages/AmericanWorkers%27SafetyConcernsDon%27tReflectReality.aspx>.

"Fall Deaths and Rates per 100,000." National Institute for Occupational Safety and Health. 2006. Centers for Disease Control and Prevention. 15 Oct. 2009 <http://www.cdc.gov/injury/wisqars/index.html>.

"Overall All Injury Causes Nonfatal Injuries and Rates per 100,000." National Center for Injury Prevention and Control. 2008. Centers for Disease Control and Prevention. 15 Oct. 2009 <http://www.cdc.gov/injury/wisqars/index.html>.

Fingerhut, Lois A. , and Robert N. Anderson. "The Three Leading Causes of Injury Mortality in the United States, 1999-2005." National Center for Health Statistics. 1 Sep. 2009. Centers for Disease Control and Prevention. 8 Dec. 2009 <http://www.cdc.gov/nchs/data/hestat/injury99-05/injury99-05.htm>.

Liman, Serife Tuba, et al. "Chest Injury Due to Blunt Trauma." European Journal of Cardiothoracic Surgery 23 3 374-378. PubMed. 16 Oct. 2009 <PMID: 12614809>.

McArthur, Barbara J. "Damage Control Surgery for the Patient who has Experienced Multiple Traumatic Injuries (Abstract)." AORN Dec. (2006): 992-1000. BNET. 8 Dec. 2009 <http://findarticles.com/p/articles/mi_m0FSL/is_6_84/ai_n27094526/>.

Udeani, John, and Sidney R. Steinberg. "Abdominal Trauma, Blunt." eMedicine. 22 Aug. 2008. Medscape. 16 Oct. 2009 <http://emedicine.medscape.com/article/433404-overview>.

General

Kaplan, Lewis J., and Daniel M. Roesler. "Critical Care Considerations in Trauma." eMedicine. 18 Aug. 2008. Medscape. 16 Oct. 2009 <http://emedicine.medscape.com/article/434445-overview>.

Source: Medical Disability Advisor






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