First Drafts and Eclampsia

First Drafts
Writing Birth Emergency Skills Training (BEST) is a very slow process. I have been working on the second edition for about 8 years. At one point I suspended writing BEST entirely in order to write The Wild Horse Dilemma: Conflicts and controversies of the Atlantic coast herds and its spin-off volumes.  For the last few years, however, I have focused exclusively on writing an expanded, comprehensive second edition of BEST that is a 90% re-write. For each segment, I must first do a literature search, read the most recent references, jot down the most important ideas, then craft the wordage.   Each chapter is comprised of many segments, and each chapter goes though many drafts before I can send it to peer review. It can take me 20 or more hours to produce just a few pages or even a few paragraphs, depending upon the complexity of the material. 

I really dislike writing first drafts. A book I read as a teenager advised something like "give yourself permission to write garbage". That advice stuck with me. I often need to remind myself that the purpose of a first draft is to capture an idea and get my basic thoughts onto the paper. In subsequent drafts I can pretty them up and come closer to the point I want to make. The words that you are reading represent the first draft of a blog that I am trying on for size, so don't judge me ;-) .

Today I am spending the day writing about eclampsia in a section of the hypertensive emergencies chapter.  I am having issues with distraction. It has been a difficult winter. I am off work (by profession I am a certified nurse-midwife) with a rotator cuff tear and a frozen shoulder. Recently, my beloved horse Dante developed founder. We tried to get her comfortable and pull her though the acute phase of the disease, but she was severely affected, and we had to put her down last week. Our other horse, Dodge, was heartbroken. Because horses are unhappy living alone, and we are too heartbroken to consider buying another horse, we gave Dodge to a young woman we know who will give him the best possible home.  Last week I was so miserable with grief and sorrow I was unable to accomplish much writing. I'm doing better now, but am uncommonly distractible. As evidenced by the fact that I started writing this blog. 
Goals for tomorrow:
My goals for tomorrow are to work in 75 minute intervals and not allow myself to succumb to distractions such as Facebook, Meridith the barn cat coming to the door, or random Google searches.
BEST Sneak Preview:
Your first draft sneak preview for today concerns the signs and symptoms of eclampsia. 

"Clinical signs and symptoms and results of laboratory evaluation cannot predict or exclude eclampsia. Approximately 20% to 40% of individuals with eclampsia do not show any symptoms before onset of seizures, and in up to 60% of cases, convulsions are the first sign of preeclampsia.   Before seizing, however, clients may develop any of the following signs and symptoms:
Hypertension (75%)
Headache (66%)
Proteinuria (86%)
Visual disturbances (diplopia (double vision), scotoma (partial loss of visual field or blind spot), photopsia (flashes of light in the field of vision) blurred vision, or transient cortical blindness (27%)
Right upper quadrant or epigastric pain (25%)
Asymptomatic (20-40%)
Other signs and symptoms include marked edema or altered mental status. 

Individuals with eclampsia usually present with tonic-clonic seizures, but some may display partial seizures or will subside into a coma without observed convulsions. Coma can also result from a brain hemorrhage or brain swelling without hemorrhage. People with occipital lobe seizures may experience visual auras and visual hallucinations before generalized convulsions At onset, the person with eclampsia suddenly loses consciousness and may emit a strange scream. During  the tonic phase, muscles of the arms, legs, chest, and back become rigid and the person is usually apneic and cyanotic. After about one minute, the muscles jerk and twitch for another one to two minutes. The person may foam at the mouth, and the sputum may be bloody if the tongue is bitten.  Some people with eclampsia experience multiple seizures in clusters. The postictal phase begins as the jerking movements resolve. The person subsides into a deep sleep with deep respirations, then over 10-20 minutes will gradually begin to awaken. A person emerging from the postictal state is often confused and groggy and may complain of a headache."

 Today my best source of information was from this reference: 
Bartal, M. F., & Sibai, B. M. (2020). Eclampsia in the 21st century. American Journal of Obstetrics and Gynecology.
I also came across a fascinating case study of a woman who survived a massive brain hemorrhage that occurred during an eclamptic seizure.  Here is the link
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385067/
And here is the the reference
​Ghaly, R. F., Candido, K. D., Sauer, R., & Knezevic, N. N. (2012). Complete recovery after antepartum massive intracerebral hemorrhage in an atypical case of sudden eclampsia. Surgical neurology international, 3, 65. https://doi.org/10.4103/2152-7806.97167

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