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.

Vasovagal Syncope


Related Terms

  • Fainting
  • Neurally Mediated Syncope
  • Neurocardiogenic Syncope

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Emergency Medicine Physician
  • Internal Medicine Physician
  • Neurologist

Comorbid Conditions

  • Dehydration
  • Emotional stress

Factors Influencing Duration

Factors influencing length of disability may include individual's response to treatment, emotional status, frequency of episodes, and cause of vasovagal syncope.

Medical Codes

ICD-9-CM:
780.2 - Syncope and Collapse; Blackout, Fainting; (Near) (Pre)syncope; Vasovagal Attack

Overview

Vasovagal syncope can be described as a temporary failure of the brain to maintain blood pressure and heart rate that causes the individual to lose consciousness and fall. Causes of vasovagal syncope include fear, pain, anxiety, trauma, blood loss, extreme exertion, prolonged static standing, physical or emotional stress, or an unpleasant sight, sound, or smell.

Incidence and Prevalence: Syncope accounts for 1% to 6% of hospitalizations and 3% of emergency department visits (Kapoor).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Episodes of vasovagal syncope usually begin in adolescence, but they can occur at any age. They are equally common in men and women. Some types may run in families.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report profuse sweating, nausea, ringing in the ears, dimming of vision, vomiting, feeling dizzy or lightheaded, feeling warm, and pale skin prior to fainting. Individuals may also report previous episodes of fainting. Some individuals may report a history of syncope following a certain event, such as urination, defecation, coughing, or swallowing. Drugs such as nitrates, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors are associated with syncope.

Physical exam: If a physical exam is performed immediately after a fainting episode, shallow and rapid breathing, cool extremities, profuse sweating, and pale skin may be evident. Slow heartbeat (bradycardia), a change in blood pressure, and heart murmur are also indications for vasovagal syncope.

Tests: Tilt-table testing is usually done to evaluate individuals with unexplained syncope. Not all individuals with vasovagal syncope need the test. During the test, the individual is strapped to a special table and slowly inclined to an angle of between 60° and 80°. In people with vasovagal syncope, this mild stress results in a drop in heart rate and blood pressure.

Transcranial Doppler ultrasonography is a noninvasive tool to assess blood flow to the brain. An electrocardiogram (ECG), complete blood count (CBC) to evaluate anemia, psychiatric testing, glucose and electrolytes tests, and a pregnancy test may need to be performed.

Source: Medical Disability Advisor



Treatment

Most individuals will not need to be treated with medications. Many individuals may need only education and reassurance. For persons with stress-related symptoms and an identifiable stressor, stress reduction therapy, including biofeedback, may be useful. Individuals should be advised to avoid predisposing factors (such as extreme heat) and to maintain adequate hydration. Medications that may be effective include beta blockers, transdermal scopolamine, theophylline, fludrocortisone, fluoxetine, and disopyramide. It is believed that vasovagal syncope may be caused by decreased heart rate (bradycardia). Pacemakers are reserved for individuals who have disabling symptoms that are not treatable with medications.

Source: Medical Disability Advisor



Prognosis

For some individuals, medication therapy may be successful in the prevention of vasovagal syncope. For others, treatment with medication is not effective, and future episodes continue to occur. Learning coping mechanisms through desensitization therapy, including biofeedback, can successfully treat stress-induced events.

Source: Medical Disability Advisor



Complications

Although some individuals may have some warning, such as dizziness or lightheadedness, some do not. A sudden loss of consciousness can result in falling and hitting the floor, which may cause fractures or other complications, such as severe head injury.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals who work with heavy machinery or who climb or work at heights may need to be reassigned to a new position. Individuals may need to work in an environment where there is physical supervision.

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 experience profuse sweating, nausea, vomiting, feeling dizzy or lightheaded, warm, and pale skin before fainting?
  • Has individual had previous episodes of fainting?
  • Does individual have orthostatic hypotension? Dehydration? Pain?
  • Has individual been standing for prolonged time? Does individual have fear, anxiety, or stress? Witnessed an unpleasant sight, sound, or smell?
  • Was physical exam performed immediately after fainting episode?
  • Did individual have shallow and rapid breathing, cool extremities, profuse sweating, and pale skin?
  • Does individual have bradycardia, change in blood pressure, or heart murmur?
  • Did individual have tilt-table testing? Transcranial Doppler ultrasonography? Were ECG, CBC, glucose, electrolyte, and pregnancy test (in females) performed?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual been treated with medications such as beta-blockers, mineralocorticoids, SSRIs, or vasopressors?
  • Has individual received education and reassurance?
  • If needed, has individual undergone stress reduction therapy, including biofeedback? Does individual try to avoid predisposing factors?
  • Do frequent episodes of syncope occur even with treatment? Has permanent cardiac pacemaker been considered?

Regarding prognosis:

  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have conditions that may affect ability to recover?
  • Has individual had any complications, such as injuries from falling?

Source: Medical Disability Advisor



References

Cited

Kapoor, W.N. "Evaluation and Outcome of Patients with Syncope." Medicine 69 (1990): 160-175.

Source: Medical Disability Advisor






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