BUENOS AIRES, 24 JUNIO DE 1996
VISTO la Ley Nº 24.557, las Resoluciones M.T. y S.S. Nros. 341 de fecha 11 de octubre de 1995 y 423 de fecha 13 de noviembre de 1995, el Acta del COMITÉ CONSULTIVO PERMANENTE Nº 6 de fecha 20 de febrero f ebrero de 1996, el Laudo del Señor Ministro de Trabajo y Seguridad Social de la Nación Nº 179 de fecha 1º de marzo de 1996, y
CONSIDERANDO: Que el COMITÉ CONSULTIVO PERMANENTE creado por el artículo 40 de la LEY SOBRE RIESGOS DEL TRABAJO y constituido por Resoluciones M.T. y S.S. Nros. 341/95 y 423/95 fue convocado el día 20 de febrero de 1996, con el fin de emitir dictamen sobre la Tabla de Evaluación de Incapacidades Laborales prevista por el artículo 8º, apartado 3 de la mencionada ley. Que
la
representación
gubernamental
en
el
COMITÉ
CONSULTIVO
PERMANENTE presentó una Tabla de Incapacidades Laborales con aplicación de factores de pond pondera eraci ción ón,, entre entre los los que que se cons consid idera erann el tipo tipo de activ activid idad ad,, las las posi posibil bilid idad ades es de reub reubica icaci ción ón laboral y la edad del trabajador. Que la referida tabla o baremo es el resultado de un profundo estudio técnico en el que han participado, en etapas previas, representantes de las organizaciones de empleadores y trabajadores. Que se ha tenido en consideración consideración para su confección la Tabla Tabla de Evaluación Evaluación de
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Incapacidades
de
Accidentes
del
Trabajo
y
Enfermedades
Profesionales
de
la
ADMINISTRACIÓN NACIONAL DE LA SEGURIDAD SOCIAL (ANSeS) 1994, la Tabla de Evaluación
de
Incapacidades
Laborativas
Permanentes
de
la
ORGANIZACIÓN
PANAMERICANA DE LA SALUD 1995 1995 y las Normas para la Evaluación Evaluación y Cuantificación del Grado de Invalidez de los trabajadores afiliados al SISTEMA INTEGRADO DE JUBILACIONES Y PENSIONES, Baremo 1994. Que también cabe destacar que esta Tabla de Evaluación de Incapacidades Laborales ha sido discutida y acordada dentro del ámbito del COMITÉ CONSULTIVO PERMANENTE de la LEY SOBRE RIESGOS DEL TRABAJO, habiendo recibido el valioso aporte de los técnicos de las partes representadas en dicho Comité. Que las representaciones gubernamental y sindical han dado amplio acuerdo a la Tabla de Evaluación de Incapacidades Laborales presentada ante el COMITÉ CONSULTIVO PERMANENTE de la LEY SOBRE RIESGOS DEL TRABAJO, votando en consecuencia por su aprobación. Que los tres integrantes de la representación empresaria votaron favorablemente, formulando reserva respecto de los factores de ponderación, en tanto que el representante de la UNIÓN INDUSTRIAL ARGENTINA se abstuvo, objetando la incidencia porcentual que podrían provoc provocar ar dich dichos os fact factore ores. s. Que, no obstante poder interpretarse la abstención como un asentimiento pasivo, ante
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Que, en consecuencia, el Señor Ministro de Trabajo y Seguridad Social en su carácter de presidente del COMITÉ CONSULTIVO PERMANENTE creado por la Ley Nº 24.557, laudó favorablemente para la aprobación de la Tabla de Evaluación de Incapacidades Laborales. Que los laudos o dictámenes emanados del COMITÉ CONSULTIVO PERMANENTE tienen por finalidad preparar la voluntad administrativa y, en particular, en el caso de los incisos b), c), d) y f) del citado artículo 40, conformarla de acuerdo con sus conclusiones, ello en virtud del carácter vinculante que la misma norma les impone. Que el PODER EJECUTIVO NACIONAL considera oportuno aprobar los dictámenes del COMITÉ CONSULTIVO PERMANENTE con relación a la Tabla de Evaluación de Incapacidades Laborales prevista por la Ley Nº 24.557 Que habiéndose cumplido con lo dispuesto por el artículo 49 disposición final 1º de la LEY SOBRE RIESGOS DEL TRABAJO, resulta procedente, a fin de conferir la necesaria seguridad jurídica a todos los interesados, que el PODER EJECUTIVO NACIONAL establezca con certeza la fecha de entrada en vigencia de la Ley. Que el presente decreto se dicta en base a las facultades conferidas por el artículo 99, inciso 2 de la CONSTITUCIÓN NACIONAL, y el artículo 8º, inciso 3 de la Ley Nº 24.557.
Por ello,
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ARTICULO 1°.- Apruébase la Tabla de Evaluación de Incapacidades Laborales que como ANEXO I forma parte integrante del presente. ARTICULO 2°.- Establécese como fecha de entrada en vigencia de la Ley sobre Riesgos del Trabajo, el día 1 de julio de 1996. ARTICULO 3°.- Comuníquese, publíquese, dése a la Dirección Nacional del Registro Oficial y archívese.
DECRETO N°: 659
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ANEXO I
LISTADO DE INCAPACIDADES PROFESIONALES
LEY 24.557
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PIEL Generalidades LAS LESIONES DE PIEL QUE SERÁN EVALUADAS, SON LAS QUE DERIVEN DE LAS ENFERMEDADES PROFESIONALES QUE FIGUREN EN EL LISTADO, DIAGNOSTICADAS COMO PERMANENT PERMA NENTES ES O SECUE EC UELAS LAS DE A C C IDENTES IDENTES DE TRABAJ RABAJ O . La evaluación de las mismas toma en cuenta: las zonas afectadas, la profundidad y extens extensiión de d e la lesi lesión, la la reper repe rc usi usión funcional y el gra gra do de dific dific ultad ultad laboral lab oral que ocasionan; en función de estos factores, se fijará el grado de incapacidad dentro del rango establecido. Elementos útiles para la evaluación: Anamnesis, examen físico y estudios c omplementari omp lementarios os espe especc ífi ífic os (test (test c utáneo, utáneo , biops biop sias ias,, inmunol inmunolog ogía, ía, etc .).
Diagnós Diagnósttico ico
% Inc Inc apac apa c idad
1.- DER DERMAT MATITIS C RÓNICA NIC A (por contacto o por hipersensibilidad. Con o sin componente de fotosensibilidad) - Crónica recidivante con remisión mayor del 50% ante medidas terapéuticas y suspensión de la exposición al agente, y recidiva habitual ante la reexposición al agente. A. Cualquier área corporal excepto cara y manos: B. Cara: C . Una Una mano: ma no: D. Dos Do s m ma a nos:
0-10% 5-20% 10-30% 15-40%
- Crónica recidivante con remisión menor del 50% ante medidas terapéuticas y suspensión de la exposición al agente, y recidiva habitual ante la reexposición al agente. A. Cualquier área corporal excepto cara y manos: B. Cara: C . Una Una mano: ma no: D. Dos Do s m ma a nos:
0-40% 10-30% 10-40% 20-60%
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- Sólo Sólo c a ra : - Manos y cara:
10-40% 20-60%
3.- RADIODERMATITIS (valorar el compromiso funcional) A - Sin lesiones ulceradas. B - Con lesiones ulceradas. - Cualquier área corporal excepto cara y manos:
A : 0-20% B: 10-40%
- Sólo manos:
A : 0-15% B. 20-50%
- Sólo Sólo c a ra :
A : 0-30% B: 20-60%
- Manos y cara:
A: 10-40% B: 20-60%
4.- QUERATODERMIAS QUERATODERMIASPALMOPLANTARES PALMOPLANTARES (crónicas con remisión menor de 50% ante medidas terapéuticas y suspensión de la exposición laboral) - Sólo plantas (evaluar en función del compromiso para la estación de pié y la marcha): - Una mano (según compromiso funcional): - Dos ma ma nos (seg (según ún comp c omprromiso omiso funciona l):
5.- ACNÉ
0-40% 0-30% 10-50%
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- Comp C omprromiso omiso menor de 50% de super upe rfic fic ie c orporal - Compromiso mayor de 50% de superficie corporal - Compromiso de cara menor del 25% - Compromiso de cara mayor del 25%
7.- PORFIRIA C UTÁNEA TARDA: Si la exposición al sol le causara trastornos funcionales:
0-15% 5-25% 0-15% 10-25% 0-30% 10-40%
8.- SÍNDROMESES SÍNDROMES ESC C LERODÉR LERODÉRMIC MICO OS:
0-20%
9.- INFECCIONESC INFECCIONES C UTÁNEASCRÓNICAS ÁNEAS CRÓNICAS Y/ Y/ O SEC SEC UELAS: UELAS:
5-15%
10.- ANAFILAXIA
0-20%
11.- DERMATITISPRE-CANCEROSAS DERMATITISPRE-CANCEROSASMÚ MÚLT LTIPLES (> 10)
10-30%
12.- CARCINOMASB CARCINOMAS BASOC ELULAR ULAR Y ESPINO Y ESPINO C ELUL ELULA AR - Sin secuelas deformantes:
0-15%
- Con C on sec uelas defor defo rmantes: mantes: - En cualquier área corporal excepto cara y manos: - En En ma nos no s: - En cara: - Con C on p érdida pa rc ial mayor mayor de 20% 20% de superfi uperfic ie de de párpados, nariz o boca:
10-20% 15-30% 20-40% 30-40%
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Las quema que maduras duras puede pue de n ser ser c a usa usa da s po r elementos eleme ntos fís físicos ico s, químic químic os o ra ra diantes dia ntes.. Métodos de evaluación: Las lesiones superficiales que curen sin dejar cicatriz ni secuelas, no serán motivo de evaluación. Para determinar el grado de incapacidad ocasionada por una quemadura, hay que tener en cuenta su extensión, profundidad, el compromiso de la movilidad articular y las secuelas estéticas. La evaluación de la pérdida de la movilidad, deberá realizarse de acuerdo con lo expresado en el capítulo correspondiente a las lesiones osteoarticulares. Para cuantificar la extensión de la lesión se aplicará la "Regla del Nueve", donde se le a signa el 36% 36% de la superfic superfic ie c orpor orpo ra l al tórax y dor do rso, el e l 36% 36% a los d os miemb miembrros inferiores, el 18% a ambos miembros superiores, el 9% a la cabeza y el 1% a los genitales (masc (masc uli ulino o femenino). femenino).
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La profundidad de la quemadura se evalúa de la siguiente manera: Ti Tipo A (superf (superfiic ial o ep idér dé rmic mic o); Ti Tipo AB (epidermi (epidermis y dermi dermiss); Ti Tipo B (der (de rmis mis hasta hasta ap oneur one urosi osiss o hueso). Al tipo "A" o primer grado, se le asignará el 50% del porcentaje de la extensión de la super upe rfic fic ie corporal c orporal les lesiiona da . En el ca so d el tipo tipo "AB" o d e segundo grado , se se le fijar fijará á un porcentaje igual al área afectada; por último, al tipo "B" o de tercer grado, se le asignará el doble de la extensión del sector aquejado. Así, por ejemplo, una quemadura de la parte anterior del brazo izquierdo, que involu nvolucc ra la c ara a nter nteriior de c odo od o y no llega llega a la mano del de l ti tipo AB, AB, le le c orres orrespo ponderá nderá una una inca pac pa c idad da d de d e a c uerdo uerdo c on el si siguiente guiente detalle: detalle: Limitac mitac ión funcional del d el cod c od o por po r retr retra a c c ión des de sde los 150ª 50ª lle lle g a a los 70ª (flexoe (fle xoextensi xtensió ó n)
20% 20%
extensión extensión de la quemad que mad ura ura
3,5% 3,5%
profundida profund idad d o tipo tipo A B
3,5% 3,5%
La sumatoria umatoria nos da : 27% de inca pa c idad . Otro ejemplo: la quemadura de los genitales externos en un hombre con una retra etra c c ión en e n la la a bducc bd ucc ión ent e ntrre a mbos mi miembros inferi nferiores y del tipo tipo AB. En este caso correspondería: Limitac mitac ión en la a bduc bd uccc ión en a mbos mbo s miemb miembrros iinfer nferiiores (símil (símil a nquil nq uilo o sis e n a b d uc c ión)
30% 30%
Extensión tensión de quemad que mad ura ura
1%
Ti Tipo de quemadur quema dura a "AB"
1%
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La sumatoria nos da: 47% de incapacidad. El compromiso de estructuras localizadas en la zona afectada (por ejemplo: ojos), será evaluado acorde a lo referido en los capítulos correspondientes.
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15.- LESIONES IONES PRODUC DUC IDAS PO POR AC C IÓN IÓN DE ANIMA ANIMAL LES PONZO PONZOÑOS ÑOSOS Se valorará el compromiso local, según el ítem correspondiente a Quemaduras; para la limitación funcional de las estructuras osteoarticulares se remite al Capítulo correspondiente. La manifestación general de la acción tóxica del veneno de serpientes y de la ponzoña de escorpiones, se valorará acorde a la secuela consolidada, para lo cual se remite al Cap. correspondiente.
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OSTEOARTICULAR Generalidades PARA PA RA LA EVALUAC IÓN IÓ N DE LAS AFECC IONES ION ES O STEO ARTIC ARTICUL ULA A RES RES SE SE TENDR TENDRÁ Á N EN CUE C UENT NTA A LAS SE SEC UEL UELAS ANÁT ANÁ TO MO -FUNC -FUNC IONA IO NALE LES S DERIVA DERIVADAS DAS DE UN AC A C C IDENTE IDENTE DEL DEL TRABAJ O O DE UNA ENFERMEDAD PROFESIONAL. Para su diagnóstico se empleará fundamentalmente la clínica y en caso de sospecha de simulación se requerirá de exámenes de apoyo tales como radiografías simples, estudios elec trofis trofisiol iológ ógico icoss, Tomo Tomografía grafía A xial Comp C omputad utada a (TAC (TAC - sc sc aner ane r), Res Resona onancia ncia Nuclear Nuclea r Magnética, potenciales evocados somatosensitivos, entre otros. Las fracturas que consoliden bien sin dejar secuela alguna (muscular, neurológica, etc.), no serán motivo de resarcimiento económico y serán consideradas incapacidad temporal.El dolor puro, no acompañado de signos objetivos de organicidad, no será objetivo de incapacidad permanente. En éstos casos estará indicado la utilización de exámenes de apoyo. En los pacientes afectados de invalideces múltiples producto de lesiones anatómicas y/o funcionales en un mismo segmento corporal se procederá a la suma de todas ellas para
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3) En los casos en que la columna se encuentre anquilosada, el mayor valor por a nquil nquilosi osis, co rres espo ponde nde a la inca pa c ida d gl g lobal ob al de la c olumna. olumna. 4) Las alteraciones anatómicas y limitaciones en los sectores cervical y/o dorsolumbar se c ombinan entr e ntre e sí cuando cua ndo c oex oe xisten. 5) Por alterac iones "c "c línica línica s" se e ntiend ntiende e fuer fue rza , tono, tono , trofis trofismo mo y reflejo reflejoss. La La limi limitac tac ión de la movilidad se valora aparte sumándose aritméticamente.
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6) De no estar contemplado el eventual compromiso neurológico en la incapacidad evaluada por secuela osteoarticular, el mismo, determinado en el Cap. correspondiente, se combinará con esta.
Consolidac onsolidación ión vic vicios iosa a Secuelas ec uelas de Fr Frac turas uras Fra Fra c tur tura de c uerpo ver ve rtebral, co n ac a c uñamiento, sin sin lesi lesión ón radicular rad icular A c uñamiento uña miento meno r d e 30º 30º A c uñamiento uña miento ma mayor yor d e 30º 30º Fractura de cuerpo vertebral operada, con lesión radicular leve a moderada, c orrob orrob orada orad a elec tromiográfica tromiográfica mente Fractura de cuerpo vertebral operada, con lesión radicular severa, corroborada electromiográficamente Fra Fra c tura tura de c uerpo verteb vertebrra l, operad op erada a , sin sec uelas Fra Fra c tura tura d e a p ófisis ófisis e sp inosa sin sec uelas ue las Fra Fra c tura tura de a p ó fisis fisis tra tra nsvers nsversa a sin sec uelas uela s Fra c tura tura de c uerpo verteb vertebrra l, sin sec uelas Fractura de cuerpo vertebral, con acuñamiento y lesión radicular leve a moderad mod erada a , c orrob orrob orada orad a elec tromiográfic tromiográfica a mente Fractura de cuerpo vertebral, con acuñamiento y lesión radicular severa, c orrob orrob orada orad a elec tromiográfica tromiográfica mente Cérvicobraquialgia post-traumática, sin alteraciones clínicas, radiográficas ni electromiográficas C érvic érvic obr ob ra quialgia post-tr post-tra umátic umátic a , c on a lterac lterac iones one s c líni ínic a s, ra diológica diológic a s y elec tromiog tromiogrrá fic fic a s leves a modera mod erada da s Herni Her nia a de disc disc o operad op erada a sin sec uelas
0-15 0-15% % 15-3 15-30% 0% 10-15 -15% 20-35% 5% 0% 0% 0% 10-25 -25% 15-40 -40% 0% 5-25 -25% 5%
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Limita imitac ión func funcional ional Sólo se evaluará la que derive de accidentes laborales. El 0° se toma con la cabeza y el tronco mirando hacia adelante.
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C olumn olumna a Cer C ervi vic c al Excursión desde 0° hasta: Extensi xtensión ón 0° 4% 10° 2% 20º 1% 30° 0% 40° a 70°
Rotación otac ión 2% 2% 1% 1%
Inclinac Inclinación ión 4% 4% 3% 3% 1% 1% 0% 0% 0%
Flexión 4% 3% 1% 0%
Flexión 9%
Extensi xtensión ón 3%
C olumna Dors Dorsolumbar olumbar Excursión desde 0º hasta: Rotación otac ión D. I. 0° 5%
Inclinac Inc linac ión D. I. 4%
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90°
60%
El porcentaje total por anquilosis es el que corresponde a la mayor cifra por tal afección, los resultados parciales no se suman.
C AJA AJ A TORÁC ORÁCIIC A Consolidación Viciosa - Secuelas de fracturas
Luxac uxac ión es ester terno-c no-clla vic vic ula ula r sin inca nc a pa c ida d Luxac uxac ión es ester terno-c no-cost osta al sin inca nc a pa c ida d Desarticulación esterno-condral bilateral, con respiración paradojal e insufi insuficc iencia ienc ia resp. sin solución oluc ión terapéutica terap éutica has ha sta 70% 70% Frac tur tura de es ester ternón nón no c omplic omplic ad a sin inca pac pa c ida d Fra Fra c tura tura de esternón esternón c omplic omplic a da según sec uelas uelas Fra Fra c tura tura de una c osti ostilla lla sin inca nc a pa c ida d Fra Fra c tura tura s c ostales múltiples múltiples,, c on c omp lic lic a c ión res respirato piratorria según eg ún sec uelas Fr tur ost les múlti múltiples ples in li ión i i ida d
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Amputac ión a nivel nivel de la metaca metac a rpofalángica po falángica del de l a nular nular Amputac Amp utac ión a nivel nivel de la inter interfalá falángica ngica proxim proxima a l del de l a nula nula r Amputac Amp utac ión a nivel nivel de la inter interfaláng falángica ica distal distal del de l a nula nula r Amputac Amp utac ión distal distal de la últi última ma falange falang e del de l a nula nula r Amputac ión a nivel nivel de la metac arpofal arpofa lángi áng ic a del de l me meñi ñique que Amputac Amp utac ión a nivel nivel de la inter interfaláng falángica ica proximal proximal de l meñique Amputac Amp utac ión a nivel nivel de la interfaláng nterfalángica ica distal distal del de l meñique Amputac Amp utac ión distal distal de la últi última ma falange fala nge de l meñique
8% 6% 5% 3% 5% 4% 3% 1%
Secuelas de fracturas A estos porcentajes se le sumarán aritméticamente los que correspondan por repercusión funcional por lesión de los nervios periféricos, no pudiendo dicha suma ser mayor a la amputación de dicho segmento. Las fracturas que consoliden sin complicaciones, no serán motivo de incapacidad
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1% 0%
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En flex flexiión de: de : 0º 10º
(Inc (Inc luye luye la Aducc Aduc c ión y Abduc Abduc c ión) ión) Inc Inc ap ac ida d En Extensi tensión de: de : Inc Inc ap a c ida d Global Global 7% 0º 7% 12% 10º 10%
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Anquilosis Anquilosis Inter Inter -Fa -Falángic lángica a Anquil Anquilosad osad a en: 0º 10º
Incapa nca pa cidad cida d global 10% 9%
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SISTEMA CARDIOVASCULAR Generalidades LAS LES LESIO IONES NES DEL SIST ISTEMA C A RDIOVA RDIOV ASC ULA ULAR QUE Q UE SER SERÁ ÁN EVALU EVA LUA ADAS DA S, SON LAS QUE Q UE DERIVEN DERIVEN DE LAS ENFER ENFERM M EDADES EDADES PROFE PRO FES SIONA IO NALE LES S Q UE FIGURE FIGUREN N EN EL LIST LISTA DO, DO , DIAG DIA G NO STICA IC A DAS DA S C O M O PERM PERM A NENTES NENTES O SECUELA ECUELA S DE A C C IDENT IDENTES ES DE TRABAJ O . Los elementos de diagnóstico que se usarán son: Anamnesis, Examen Físico. Laborato Lab oratorrio: C olesterol olesterol tota l, Colest C olesterol erol HDL, HDL, C olesterol olesterol LDL. LDL. Función rena l, CPK, C PK, LDH, LDH, TG TG O, TG TG P. Dia Dia gnósti gnóstic o por po r imág imágenes: enes: Rx, Ec Ec o, C á mara G ama , Dopl Dop ller ler,, Hemodinamia Hemodinamia . Electrofisiológico: Ecg, PEG, Holter, Presurometría. Fondo de ojo.
Afecciones 1. Cardiopatía Coronaria. 1.1. 1.1. Síndrome a nginoso. 1.1.1 .1.1.. Angina Angina de d e pec pe c ho crónic crónic a y estable. estable. Comprobado Comproba do c on PEG PEG y/o y/ o Ta lio lio y/o y/ o Hemod Hemo d inamia p o sitiva itiva 1.2. 1.2. Infa Infa rto del de l mioc mioc a rdio. 1.2. 1.2.1. 1. Infa Infa rto del mioc mioc a rdio rec rec uper upe ra do, do , tra tra tado tad o médica médic a mente o en forma quirúrgica, sin alteraciones hemodinámicas y PEG submá ub máxi xima ma neg ne g a tivo 1.2. 1.2.2. 2. Infa Infa rto del mioc mioc a rdio rec rec uper upe ra do , tra tra tado tad o médica mente o en forma quirúrgica, con isquemia residual y/o trastornos hemod iná iná mic mic os y/o PEG PEG test test de esfuerz esfuerzo o submáx ubmá ximo imo po siti itivo
Porcentaje
60%
20-3 20-30% 0%
80% 2 Insuf nsufiic ienci enc ia c ardiac ardiac a der d erec ec ha. (complic (complic ac ión de patologí p atologías as pulmonares de origen laboral), agrega en forma aritmética a la enfer enfe rmeda med a d que le dio orige origen n 3. Síndrome índrome angioneuróti a ngioneuróticc o de d e la mano p redominantes ed ominantes en los dedo de do s índic ndic e y med mediio a c ompa ñados ñad os de c alambres de la mano y dis disminución minución de la sensibilidad (Enfermedad Profesional). C ompromis ompromiso de una mano C o mpromis mp romiso o b ila ila teral 4. C ompr omp romiso omiso vascular unilateral unilateral per pe rmanente, mane nte, c on fenómeno d e Raynaud Rayna ud o ma manif nifest esta a c iones isqué isquémi micc a s de los de dos do s. 5. Tra stornos de la c irc irc ulac ión per pe rmanente mane nte de los dedo de do s de ma nos y pies. 5.1. 5.1. Tra stornos de la ccir ircc ula ula c ión de los de do s de las manos mano s y de los p ies sin sin a c roo roossteo te o lisis lisis 5.2. 5.2. Tra stornos de la cir c ircc ula ula c ión de las la s mano s y de los pies c on a c roo roosteo steolis lisis is
30%
5% 10% 20%
15% 15% 25% 25%
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6. Hipe Hiperrtensión tensión a rteria teria l (HTA) c omo sec sec uelas de nefrop nefropa a tía tía s profesionales: Se tendrá en cuenta, Rx, Eco, Cámara gama, Ecg, Fondo de ojos - Estadío I: Las cifras de presión diastólica son repetidamente superiores a 90 mm Hg, Electrocardiograma (ECG), Rx, Eco (sin hipertrofia ventricular) y fondo de ojo normal ,sin antecedentes de lesión les ión c erebr ereb ro vas va sc ular po r HTA - Estadío II: sin antecedentes de lesión cerebro vascular por HTA, sin secuelas en el momento de la evaluación, con evidencia de hipertrofia ventricular izquierda y fondo de ojo con alteraciones a rteriola rteriolares res p o r HT HTA A sin hemo he morr rra a g ias o e xuda ud a d o s - Estadío III: Hipertrofia ventricular izquierda al ECG y ECO .Rx de tórax sin signos de congestión cardíaca, retinopatía con cambios defi de fini nido doss por po r HTA c on hemor hemo rra gias gia s y exudado exuda doss - Estadío IV: A todo lo anterior se le suma la Insuficiencia Cardíaca o los Ac c identes de ntes C erebrovasc erebrovasc ula ula r por HT HTA o la Retin Retinop opa a tía tía por po r H HT TA c on da ño retina etina l o de nervio nervio óp tic tic o
5%
20% 20% 40% 70%
Lesiones iones ana anattómica ómic as Post Post Traumática umáticas Pericardio Ta Ta ponamiento, po namiento, operad op erado, o, si sin sec sec uela funciona l Ta Ta po namiento, op erado, erad o, c on sec sec uela func func ional ona l Pericarditis: empiema, empiema , drenaje quirúr quirúrgico gico , sin sec uela hemodin hemod iná á mic mic a c on sec uela hemodiná hemo dinámi micc a c onstrictiva, onstrictiva, c o n reperc ep ercus usión ión hemod hemo d inámica Corazón Lesiones de Miocardio Herid Herid a d irec irec ta, ta , que qu e req uiera c irug irugía ía Grandes Vasos (que requieran cirugía) Arteriales: Pulmonar A orta, orta , sin sec uela ue la c on sec uela Subc ub c lavia, lavia , sin sec uela ue la c on sec uela (by pa ss) Aor Ao rta a bdo minal minal O per pe ra da , sin sec uela O per pe ra da , con c on sec uela, a neuris neurismáti máticc a o es estenos tenosiis, que requiere requiere cirugía
sin inc inca a pa c ida d 50-70 -70% sin inca nc a pa c ida d 40-70 -70% 70% 40-7 40-70% 0% 30% 40% 40% 70% 70% 0% 50% 50% 30% 70%
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C a va super upe rior, sin sec uela c on c ompl omp lic a c iones one s Pulmonar Subc ub c lavia Vena Cava inferior O per pe ra da , sin sec uela O per pe rad a, c on sec uela uela Linfátic infáticos: os: C ond ucto uc to torác ico, ico , quilotó quilotórra x (Si queda secuela pleural, ver Cap. Respiratorio)
0% según sec uela uela 30% 30% 30% 0% 40% 30%
DIGESTIVO Y PARED ABDOMINAL LAS LESIONES DEL APARATO DIGESTIVO Y PARED ABDOMINAL QUE SERÁN EVALUADAS, SON LAS QUE DERIVEN DE LAS ENFERMEDADES PROFESIONALES QUE FIGUREN EN EL LISTADO, DIAG NOS NO STICA IC A DAS CO C O M O PERM PERM A NENTE NENTES O SECUELA ECUELA S DE AC C IDENT IDENTES ES DE TRABAJ O . Elementos útil útiles es pa ra la e valuac ión: Anamnesis, Examen físico, Laboratorio. Endoscopía Diagnóstico por imágenes: Rx simple, Rx con contraste, T.C., ECO, RMN, Centellograma.
C AVIDAD BU BUC AL Pérdida Pérdida de pa rtes blandas bland as (Ver Ca bez be za y Rost Rostrro)
Estomatitis
Incapacidad
1.- Es Estoma titi titiss mercur merc urial ial co n pér pé rd ida de menos meno s de 1/3 1/ 3 de las piezas de ntaria ntaria s c omo sec uela. uela . Estomatitis mercurial con pérdida secuelar de 1/3 o más de las piezas dentarias. 2.- Pérdida tra tra umáti umá ticc a de menos meno s de 1/3 de piezas pieza s dentari de ntaria a s. Pérdida tra tra umáti umá ticc a de má máss de un tercio de las piezas pieza s de ntaria ntaria s.
20 % 40% 20% 40%
Nota: En lo que concierne a pérdida de piezas dentarias por estomatitis mercurial o traumáticas secundarias a accidentes laborales, sólo se otorgará la incapacidad señalada en el caso que dichas pérdidas no sean reemplazadas por prótesis fijas, es decir con puentes o impla implantes ntes de titanios. titanios.
Lengua 1. Pérdida pa rc ial, sin a lterac lterac ión de la fona c ión y de la degluc de glución. ión. 2. Pérdida Pérdida pa rc ia l, c on a lterac lterac ión de la fonac fona c ión y de la deglución. de glución. 3. Pérdid Pé rdida a To tal. ta l.
10-15 -15% 15-30 -30% 50-60 50-60% %
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Los accidentes de trabajo que originan lesiones en el esófago son excepcionales. Pueden Puede n ser ser provoca provoc a da s a nivel nivel del de l c uello uello y/o el e l tórax tórax c omo c onsec onsec uenci uenc ia de d e la la inge ingessta de cáusticos o por heridas penetrantes en esas regiones. Estas últimas habitualmente van acompañadas de compromiso en otros órganos. Las secuelas se relacionan directamente con la lesión que las provocó o pueden ser sec undar unda ria s a l tr tra tamiento, tamiento, que q ue nec ne c esar esariia mente deb d ebiió ser rea rea liza iza do . En la anamnesis se tendrá especial interés en la valoración de la disfagia, el dolor y los vómitos. En el examen físico se considerará el estado nutricional. Se requerirá el aporte de la His Historia toria C líni línicc a , con c on los proc proc ed imientos mientos diagnó dia gnósstic tic os y tera tera péuti pé uticc os rea rea liz liza do s.
Lesiones 1.- Perforación simple, sin flemón de cuello y/o mediastinitis, sin secuelas. 2.- Secuela leve: con disfagia intermitente, con disquinesia, sin e steno ten o sis y sin c o mpromis mp romiso o p o nde nd e ral. 3.- Secuela moderada: - con c on es estenos tenosiis y neces nec esiida d de dilata dilatacc iones per pe riódi ód ic a s sin pérdi p érdida da de peso o con pérdida menor del 10% del peso habitual.
sin inca inca pac pa c ida d 2-10% -10%
10-15% - con co n pér pé rdida mayor del 10 10% del de l peso peso ha bitual bitual y con co n esc esc aso c ompr omp ro miso miso d el estado estad o ge neral. nera l. - con pérdida mayor del 10% del peso habitual y moderado c ompr omp ro miso miso d el estado estad o ge neral. nera l. Perfor Perfora a c ión de d e e sófago ófa go torac torac oa bdomi bd ominal nal res resuel uelta ta por p or toracolaparotomía o toracofrenotomía y cierre de la brecha con el fundus fund us gá stric trico o (Op. (O p. d e Thal) ha l) o similares imilares 4.- Secuela grave: Perforación en mediastino, que requiere drenaje quirúrgico o extirpación del esófago, reemplazo del mismo con estóma estóma go, go , c olon o intes intesti tino no de lgado lga do Necrosis (lesiones por cáusticos), con reemplazo quirúrgico del esófago Estenos teno sis total, tota l, que req uiere uiere ree eempla mplazzo q uirúr uirúrgic gico o de l esófago esófa go Cualquiera de estas tres secuelas, sin posibilidad de reparación quirúr quirúrgica gica , salvo salvo o stomía tomía de a limentac ión y/o alimentac alimentac ión parenteral
15-25 -25% 30-50 -50% 25-3 25-30% 0% 70% 70% 70% 80-90%
ESTÓMAGO Y DUODENO El estómago y el duodeno pueden ser lesionados por contusiones violentas en la región eg ión epigás epigá stri tric a y zona zona ba ja del de l tóra tóra x por po r herida herida s penetr pe netra a ntes a bdominales bd ominales y ta ta mbién por po r
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En todos éstos casos se impone la intervención quirúrgica, donde se determinará el tra tra tamiento respe respe c tivo: tivo: des de sde e l c ierre ierre simple simple hasta hasta a mplias resec c iones. Por Po r tal motivo, motivo, es importante requeri req uerirr c o pia del d el par pa rte quirúr quirúrgic gico o y los estudios c omplementa omp lementa rios rea liz liza do s.
ESTÓMAGO Lesiones 1. Lapa Lap a rotomí oto mía a explorad ora sin sec uela 2. Gastrectomía parcial: 2.1 c o n p érdida érd ida meno men o r d e l 10% 10% d e l pe so hab ha b itual 2.2. 2.2. c o n p érdida érd ida ma mayor yor d el 10% 10% d el p eso hab ha b itual 2.3. con secuelas post quirúrgicas (Dumping Síndrome del asa a ferente) c on pér pé rdida menor meno r del de l 10% 10% del de l pes pe so habitual ha bitual 2.4. .4. con c on sec. sec . po st quirúr quirúrgica gica s (Dumping, (Dumping, etc .), co n pérdi p érdida da mayor d el 10% 10% d el p eso c o rpor rpo ra l 3. G a strec trec tomía total: tota l: sin pér pé rdida did a de pe so 3.1. 3.1. c on pér pé rdida menor meno r del de l 10% 10% del de l pes pe so habitual ha bitual 3.2. .2. con c on pérdi p érdida da mayor del 10 10% del de l peso peso hab itual itual y moderad mod erado o c ompr omp romiso omiso de l estado estad o ge neral nera l 3.3. .3. con c on pérdida p érdida mayor del de l 10% 10% del de l peso habitu ha bitua a l e importa importa nte c ompr omp romiso omiso de l esta esta do general, ge neral, c on o sin sec uela de reflujo eflujo
0% 15-2 15-20% 0% 20-2 20-25% 5% 25-35 -35% 35-4 35-40% 0% 30% 30-35 -35% 40-50 -50% 70%
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DUODENO 1.- Duode Duodenopa nopa ncreatec tomía: tomía: c efáli efá licc a total 2.- Liga Liga dura de l píloro c on c ierr ierre simple imple y ga stroe troe nteroana nteroa nasstomos tomo sis
45% 45% 70% 20-30 -30%
INTESTINO DELGADO Como toda víscera hueca, puede ser lesionada por traumatismos abdominales y/o herida herida s penetr pene tra a ntes. ntes.
Lesiones 1.- Laparotomía exploradora sin secuela, por cierre simple sin sin incapacidad resección 2.- Resec Resec c ión: meno me nores res d e 60 c m. 5-10 5-10% % si involuc invo lucra ra e l á ngulo ng ulo d e Treitz 15-25 15-25% % de más de 60 cm (val (va lorar estad estado o nutr nutricional): c on pérdida p érdida menor del de l 10 10% del de l peso hab itual, hipoa hipo a lbuminemia, lbuminemia , no meno r a 3 gr. 25-30 -30% c on pérdi p érdida da mayor del 10% 10% del de l peso peso habi hab itual, hipoa hipo a lbuminemia, no meno r a 3 gr. y/o y/ o a nemia 30-40 -40% con pérdida mayor del 10% del peso habitual, albuminemia menor a 3 gr. gr. y/o a nemia nemia o c ompromis ompromiso funci func iona l tipo tipo 70% intes intesti tino no c orto 3.- En caso de producirse fístulas, permanentes, que comprometan el esta esta do general, ge neral, a grega greg a r: 25%
INT INTEST ESTINO GRUES RUESO O Las causas de las lesiones son similares a las referidas para Intestino Delgado.
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Si la resección motiva trastornos funcionales, que comprometen el estado general (pérdida de peso, anemia, hipoalbuminemia, diarrea crónica) la incapacidad se incrementará en 15%. Para evalu e valuar ar las las Colec C olectomí tomías as sse e solic olic itará tará Rx de C ólon por po r enema y C olonosc olonosc opi op ia.
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RECTO y ANO Las lesiones son, por lo general, producto de traumatismos contusos penetrantes. 1.- Perforación de recto, extraperitoneal, con colostomía tra tra nsit nsito o ria, re c onstruido onstruido el trá trá nsit nsito o a l momento mome nto d e la eva luac ión 2.- Perforación de recto, intraperitoneal, con cierre simple y c olostomía olostomía tra tra nsit nsitori oria a , rec rec onstr onstruido uido el trá trá nsit nsito o a l momento de la evaluación 3.- Perforación de recto, intraperitoneal, con Operación de Hartmann 4.- Per Pe rforac fora c ión de rec to, c on c olo olosstomía d efinitiva efinitiva Fístulas Anales (post-traumáticas o complicaciones posttraumáticas) sin solución terapéutica: Subc utánea utáne a Tr Tra nses nsesfi fint nteri eriana ana Extraesfinteriana Fisura Fisurass sin sin lesión d e l e sfínte sfínterr c o n lesi lesió ó n d e l e sfínter
10-15 -15% 10-15% 25-30% 40-60 -60% 1-3% 1-3% 10-20 -20% 10-20% 0-2% 0-2% 2-5% 2-5%
Si con motivo de las resecciones o lesiones se produce un trastorno funcional per pe rmanente: mane nte: inc inc ontinenc ontinenc ia , obstr obstrucc uc c ión defec defe c a tori toria por po r es estenosi tenosiss y/o lesi esión ón nervios nerviosa a , la la inca pa c ida d se incrementará ncrementará en 30% 30%.
PARED ABDOMINAL Cicatrices viciosas, retráctiles, anfractuosas: menores meno res d e 10 c m. mayores ma yores d e 10 c m. Ruptura uptura del de l rec to a nteri nterior, operad op erado o o no que, que , c ura ura sin sec uela
2% 5% sin inca nc a pa c ida d
HERNIA EVENTRACIÓN O EVISCERACIÓN DIAFRAGMÁTICA POST-TRAUMÁT MÁTICA IC A Sin c omplic omplic a c iones
sin inca nc a pa c ida d
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menor meno r de 6 c m, sin solución oluc ión terapéutica terap éutica mayor ma yor de 6 c m. sin so lución luc ión terap tera p éuti éu ticc a gigante, giga nte, más de 25 c m., no repa ep a ra ble
6-12 -12% 13-1 13-16% 6% 40%
Si hay complicaciones que requieran cirugía y esta le dejara alguna secuela, se le sumará a la incapacidad evaluada la correspondiente al tipo de intervención realizada. Par Pa ra ello se se remite remite a l ítem ítem corr c orrespo espondiente ndiente (por (p or ej. resec eseccc iones intest intestinales inales). ).
HÍGADO Y VÍAS BILIARES Los accidentes de trabajo que originan lesiones a éste nivel pueden ser debidos a la ingesta de tóxicos, contusiones ó heridas penetrantes. El hígado, también puede ser afectado por ciertos agentes infecciosos (Hepatitis B, Hepatitis C, u otras) o trabajar con algunas sustancias tóxicas Elementos útil útiles es pa ra la e valuac ión: Anamnesis, Examen físico. La bor bo ratorio atorio G eneral: Es Espec pe c ífic fic o: Hepa tograma tograma , Protein Proteinog ogrrama , G a mma mma G T., Estudio de d e la hemos hemo stasia tasia , Colinesterasa sérica, Arco 5, Marcadores virales Diagnóstico por imágenes: Rx, Eco, TC, RMN. Los daños que originan las lesiones difusas hepáticas, se evaluarán en base al c ompr omp romiso omiso funciona l: signos clíni clínicc os y de la bo ra torio. torio. La biops biop sia es un elemento va lios ioso. o. En las lesi lesiones one s anatómi ana tómicc a s seg segmentari mentaria a s ó foc fo c a liz liza da s el diagnóst diag nóstico ico p or iimág mágene eness es indispensable.
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La s les lesiiones one s difus difusa s del de l híga híga do, do , cualquier c ualquiera a sea su etiolog etiología, ía, produc prod uciida s en o c a sión de l trabajo, serán evaluadas de acuerdo a los parámetros precedentes. Los valores extremos de inca pa c ida d de d e c ad a es estadio, tadio, se se c orrelac orrelaciionan c on: la la His Histori toria C línic nic a, la frec frec uencia de las d escompe esco mpens nsa a c iones y los da tos humorales lími límites tes expresa expresa d os. La Hepatitis crónica activa, aún compensada, diagnosticada por biopsia, puede llegar a alcanzar una incapacidad del 70%, dependiendo del grado de actividad inflamatoria histológica, los parámetros clínicos, la alteración de los valores humorales y el tipo de actividad laboral. Angi Ang iosar osarcc oma hepá tic tic o
90%
Lesiones anat anatómic ómica as Hígado La s les esiiones one s tra tra umátic umátic a s de híga híga do que c uren uren sin sin sec sec uelas no no presentan presentan inca pa c ida d. Las lesiones traumáticas de hígado que dejen secuelas se evaluarán según las mismas. Por ejemplo: Insuficiencia Hepáticas, sinéquias, etc. Quiste hidatídico simple, con resección quirúrgica sin complicaciones Q uis uiste hida hida tídic tídico o c ompl omp lica do : Ruptur Ruptura a (siembr (siembra a pe ritonea l) Recidiva Rec idiva c on siembra per pe ritone itonea al
sin incapacidad 70% 80%
C uando c oexis oexiste con c on compli c omplicc ac ión torác torác ic a, se se c ombinarán ombinarán las las inca inca pa c ida des de s. De existir compromiso de la función hepática post - resección, la misma será evaluada a partir de los parámetros mencionados en el correspondiente ítem. Las lesiones, producidas por y en ocasión del trabajo, que den origen a un transplante hepático se valoran en un 90%.
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Sutur utura esplénica esplénica , pos po st tra tra umátic umátic a (sin (sin esplene esplenecc tomía tomía ) Esplenec plene c tomía tomía pa rc ial, po st tra tra umática Esple Esplene necc tomía total, tota l, po st tra tra umáti umá ticc a
sin inca nc a pa c ida d 10% 25-30 -30%
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SISTEMA NEFROUROLOGICO Generalidades LAS LES LESIO IONES NES DEL SIST ISTEMA NEFRO NEFRO URO URO LÓG ICO IC O Q UE SERÁ ERÁ N EVALU EVA LUA A DAS DA S, SO SO N LAS LA S Q UE DERIVEN DERIVEN DE LAS ENFER ENFERM M EDADES EDADES PROFE PRO FES SIONA IO NALE LES S Q UE FIGURE FIGUREN N EN EL LIST LISTA DO, DO , DIAG DIA G NO STICA IC A DAS DA S C O M O PERM PERM A NENTES NENTES O SECUELA ECUELA S DE A C C IDENT IDENTES ES DE TRABAJ O . Los elementos eleme ntos úti útiles les pa ra la e eva valuac luac ión son: son: Ana A namnesi mnesiss, Ex Exa men Fís Físico Laboratorio: Hemograma, uremia, creatininemia, Clearence de creatininemia o insuli insulina na,, etc e tc.. Diagnóstico por imágenes Rx, Eco, TC, RNM, radiorrenograma isotópico y/o Cámara G a mma( se se pod p odrrá observar observar la función función de c ad a riñón por po r sepa ep a rad o
RIÑÓN Insuficiencia Renal La pa p a tología rena renall oc a sionada ona da por po r c ualquiera ualquiera de d e los a gentes ge ntes tóxi tóxic os que incluye incluye la ley ley debe ser evaluada en base a la función renal del trabajador, independientemente del tipo de daño, (tubular, intersticial, glomerular, con síndrome nefrótico, con síndrome urémico etc.) El monto de incapacidad por este concepto depende del grado de insuficiencia renal
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Como método de diagnóstico para evaluar la función de cada riñón por separado, se uti utilizará el ra ra diorr diorrenog ra ma isotóp isotópiic o y/o C áma ra G a mma. Las lesiones post-traumáticas, se evaluarán según las secuelas y una vez agotados los rec urs ursos terapéutico terap éuticoss. Hidrone Hidronefr frosi osiss unilatera unilateral, l, sin sin rep rep ercus erc usión ión func ional, iona l, con c on riñón c o ntra ntra lateral late ral nor no rma mall 5% Hidronefr Hidronefrosi osiss uni unilater latera a l, con co n 1/3 d e a nula nula c ión funcional funciona l, c on riñón iñón c o ntra ntra lateral late ral nor no rma mall 10% Hidronefr Hidronefrosi osiss uni unilater latera a l, con co n 2/3 d e a nula nula c ión funcional funciona l, c on riñón iñón c o ntra ntra lateral late ral nor no rma mall 15% Hidronefros Hidronefrosis is unilateral, unilateral, co n anul a nula a c ión funciona l total, con c on riñón iñón c o ntra ntra lateral late ral nor no rma mall 20% Hidronefr Hidronefrosi osiss unilater unilatera a l, con c on a nula nula c ión funciona l total, c on riñón según función rena c ontra ontra lateral dis d ismi minuí nuído do Hidronefros Hidronefrosis is unilateral, unilateral, co n anul a nula a c ión funciona l total, con c on riñón iñón según función rena contralateral sin función Hidronefros Hidronefrosis is bila bila tera tera l, c on a nula nula c ión funci func iona l de a mbos mbo s riñone iñoness según eg ún tabl tab la Ptosis renal unilateral, sin repercusión funcional, con riñón c o ntra ntra lateral late ral nor no rma mall 5% Ptosi Ptosis rena l unil unila tera tera l, con co n 1/3 de d e a nula nula c ión funcional, funciona l, con co n riñón riñón c o ntra ntra lateral late ral nor no rma mall 10% Ptosis Ptosis renal renal unil unila tera tera l, c on 2/3 2/ 3 de a nula nula c ión funcional funciona l, con c on riñón iñón c o ntra ntra lateral late ral nor no rma mall 15% Ptosis Ptosis rena l unil unila a teral, co n anul a nula a c ión funciona l tota total, l, con co n riñ riñón ón
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Bila ila teral, sin a lterac lterac iones funciona func ionales les Bilateral, c on a nula nula c ión funcional funciona l Ureterostomía C utánea utáne a pe rma manente nente unila unila teral C utánea per pe rmanente mane nte bila bila tera tera l
sin inca pa c idad ida d según eg ún func func ión rena 40% 70%
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VEJIGA C áncer áncer vesica vesicall (por (p or expos expo sición a tóxi tóxic os) El criterio para establecer el grado de incapacidad física de un Cáncer vesical y que c on mucha proba bili bilida d lleva lleva a la muerte muerte del trab trab ajador ajad or tiene tiene que ver c on el grad grad o de función perdida pero también con el pronóstico y posibilidad de sobrevida del mismo. Par Pa ra tales efec efe c tos se se esta esta blec en los sigui siguientes entes cr c riteri iterios: os:
Estad stadio io 0 A B C D1 D2
Grado de c ompromis ompromiso o Supe up e rfic rfic ial o in situ, muco muc o sa Supe up e rfic rficial, ial, submuc ub muco o sa Invasor, Inva sor, muscula musc ularr Invasor, Invasor, gras gra sa pe rivesi ivesicc a l M eta stás tá sico , ga nglios linfá linfáti ticc o s M e tas ta stás tá sico , hues hue so s o vísc vísc era erass
Incapa Inca pac c idad 10% 10% 20% 20% 40% 40% 60% 90% 90% 90%
Sin perjuicio de lo anterior, si dentro de los 36 meses extendibles a 60 que establece la ley como período de incapacidad provisoria, se produjera un aumento del compromiso del cáncer vesical desde los grados A o B a un grado C o superior, deberá otorgársele al trab trab ajador, ajad or, una inc inc ap ac ida d del 90 %.
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Las lesiones uretrales, por accidentes laborales evaluarán posterior a las reparaciones quirúrgicas, si correspondieran, y según secuelas. Estr Estre e c hez he z uretral, p o st tra tra umática umá tica p e rmeab rmea b le Estrec trec hez uretral, uretral, po st tra tra umáti umá ticc a infr infra nque a ble Fís Fístula uretra uretra l, p o st tra tra umática umá tica d efinitiva efinitiva
10-2 10-20% 0% 70% 70%
GENITAL MASCULINO C a stra tra c ión Amputac Amp utac ión total del de l pene pe ne Amput Amp uta a c ión pa rc ia l del de l pene pe ne c on func func ión erécti eréc till c onserv onserva a da Amputac Amp utac ión pa rc ial del de l pene pe ne sin función func ión eréc til til Les esiión penea p eneana na d eformant eformante e d el pene c on des d esvi viac ac ión de d e la a ngulac ngulac ión o les lesiión de los c uer ue rpo s c a vernosos A trofia trofia testicula testicularr unila unila teral, p or c ontusión ontusión (hema toc ele orga niza niza d o) Atrofia testicular bilateral, por contusión (hematocele organizado)
40% 40% 25% 30% 20% 10%
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Desga Desgarrro d e peri p erineo neo p roducido od ucido por po r a c c ident de nte, e, c on c ompromi ompromiso esfinteriano, se evalúa según incontinencia Fís Fístula recto-va rec to-va g inal sin so lución luc ión q uirúrgic uirúrgica a Herid Herid a o tra tra umatis uma tismo mo en ma mama mass, c on de struc truccc ión pa rc ial unila unila teral Herid Herid a o tra tra umati uma tissmo en ma mama mass, c o n de struc truccc ión total tota l unila unila teral Herida Herida o tra tra umati uma tissmo en ma mama mass, c on de struc truccc ión pa rcial rcia l bilateral bilate ral Herida Her ida o tra tra umatismo umatismo de mama s, c on de struc truccc ión total tota l bila bila tera tera l
30% 30% 0-5% -5% 10-15 -15% 10-15 -15% 30%
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SISTEMA HEMATOPOYETICO LAS LES LESIO IONES NES DEL SIST ISTEMA HEM HEM ATO POYÉT PO YÉTIC ICO O Q UE SERÁ ERÁN EVALUADA EVA LUADAS S, SO SO N LAS QUE QUE DERIVEN DERIVEN DE LAS ENFER ENFERM M EDADES EDADES PROFE PRO FES SIONA IO NALE LES S Q UE FIGURE FIGUREN N EN EL LIST LISTA DO, DO , DIAG DIA G NO STICA IC A DAS DA S C O M O PERM PERM A NENTES NENTES O SECUELA ECUELA S DE A C C IDENT IDENTES ES DE TRABAJ O .
1.- ENFERMEDADESHEMA HEMAT TOLOGICA IC AS DE TIPO HIPO HIPOPLASIA, IA, AP APLASIA O DISP DISPLASIA, IA, que pued en manifes manifestars tarse e por po r:
Anemia, leuconeutropenia, trombocitopenia. Para los efectos de evaluar el benzolismo se tendrá en cuenta los siguientes pa rámetros ámetros hematológico s, seg según ún c omplejida omplejida d:
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• •
•
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Leuc o c itos: 20.000 20.000 - 50.000 50.000 x mm3 Fórmula leucocitaria: Granulocitosis (80 a 90% de polinucleares neutrófil neutrófilos os con c on o sin metamieloc itos itos o mieloc mieloc itos) itos) Linfocitosis: 50 a 80% de linfocitos maduros y el resto pueden no serlo Mielograma: Mielograma : Present Presenta a sólo una leve hipe hiperrplasia plasia de la línea línea interesada con indemnidad de la serie roja y plaquetaria Serie roja: Norma N ormall Pla Pla quetas: que tas: Normales
2.- LEUCEMIAS Las leucemias de origen profesional son secundarias a una exposición de más de 10
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El grado de incapacidad dependerá del estadio en que se encuentre la enfermedad según eg ún la la c la sific fic a c ión internac nternac iona l.
Estad stadio io A
C aract arac terís erístticas icas Linfoci nfoc itos c on a fectac fec tac ión c línic nic a de menos
Incapa Inca pac c idad
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NEUROLOGÍA Generalidades
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a ) Sin c ompli omp licc a c iones b) Con complicaciones: Hiposmia Anosmia
Nervio Óptico: Ver capítulo de Ojos.
0% 5% 10%
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Bilateral: c on dificultad pa ra el habla ha bla con dificultad para deglución -líquido -sólido -alimenta ión tubo
5-30 -30% 10-15% 15-30% 40-60 -60%
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Sensibilidad promedio S2 (60% de incapacidad sensitiva) Ponderac ión funcional del nerv nerviio mediano en la muñec muñec a: Componente motor 40%, y componente sensitivo 60% (mayor impo imporrtanc ia funcional func ional tiene tiene el comp c ompone onente nte sens sensit itiv ivo) o) Lesión completa del nervio mediano: 25% de incapacidad Componente motor: 25 x 0,40 = 10% x 0,60 (M3) = 6% (incapacidad motora)
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