Summer Martin

2/26/2016
Nutr. 409
Journal #2
UCSD Burn Unit
At the UCSD Hospitals Burn Unit, we met with Staci Halac, an RD who
has worked for the hospital for the last 5 years and exclusively for the
burn unit for the last 3 years. Her patients range from those who have
minor to very severe burns over their body, or even those who have
suffered inhalation burns. Staci explained that the patients burns range
from chemical, flame, electrocution, necrotizing skin infections, TENS,
Steve Johnson disease, friction, or scalding water. She said that most
children admitted to the burn unit were due to accidental scalding by
water or beverages. According to the national report put out by the
American Burn Association in 2012, 44% of burns were due to flame, 33%
were due to scalding, 9% were due to contact with a hot object, 4% were
from electrical, and 3% were due to chemical burns2.
As one of the RDs for the burn unit, Staci described the nutrition care
that she provides for her patients. She explained that in most cases she
uses indirect calorimetry for patients that are severely burned and/ or
using a ventilator. She uses the Irene Jones formula for energy needs for
all of her other patients. She will give her patients a higher amount of
protein for wound healing, of 1.5-2 g/ kg. She gives all of her patients a
multivitamin and zinc supplements regardless of the burn severity. She

also supplements with vitamin D, Vitamin A with all of her patients after
30 days. According to the article, Burn Teams and Burn Centers: The
Importance of a Comprehensive Team Approach to Burn Care, Registered
Dieticians are an integral part to the recovery of a severely burned
patient. The article states: Patients with major burns require intense
nutritional support to address massively elevated energy and protein
demands. Hypermetabolism and muscle-protein catabolism following
major burns increases proteolysis by up to 50% and leads to debilitating
losses in lean body mass1.
I got the impression that Staci is very happy with her job. The two most
important things to her were that she gets to help people who are
temporarily sick get better and that she gets to decide how much and
what type of nutrients to give the patient for their wellness. She said that
even though these patients may be severely burned and some may be
children, nothing makes her happier than seeing these otherwise healthy
people get back to their lives through her help. Patients who have cancer
or kidney disease dont have the same outcomes necessarily. She also
said that she is in control of deciding how best to treat a patient with
nutrition without having to just recommend the diet to the physician. This
is an important aspect of her position because MD approval is required in
most cases. I believe this is due to the fact that nutrition is so important
to the recovery of the burn victim and the RD is an expert.

In order to provide the best nutrition for her patients, Staci consults
with other RDs in the field and uses the ASPEN Core Curriculum, or the
ESPEN Core Curriculum. For patients that are on a P.O. diet, she provides
an extra 500 kcals a day as well as 20 g/kg of protein. Because burn
patients are suffering from catabolizing processes, it is important to feed
the patient as much as possible, because in all cases the patient will lose
weight.
Personally, I would not be interested in working as an RD in a burn unit.
I dont think I could handle seeing people in that condition and especially
with open wounds. I would also be very upset by seeing children with
burns. I do appreciate the fact that she is able to experiment and research
what nutrients to supplement with for better healing for her patients and
that she is a well respected member of her team. I felt that the overall
take home message of the visit was that nutrition care for burns is
incredibly important for the patient to recover.

References
1. Al-Mousawi, Ahmed A., Gabriel A. Mecott-Rivera, Marc G. Jeschke,
and David N. Herndon. "Burn Teams and Burn Centers: The
Importance of a Comprehensive Team Approach to Burn Care."
NCBI. National Institutes of Health, Oct. 2009. Web. 25 Feb. 2016.
2. "2012 National Burn Repository." (2012): 3. American Burn
Association. Web. 25 Feb. 2016.
<http://www.ameriburn.org/2012NBRAnnualReport.pdf>.