Bio

Clinical Focus


  • Prehospital Emergency Care
  • Comparative Effectiveness Research
  • Emergency Medicine
  • Emergency Medical Services

Academic Appointments


Honors & Awards


  • EMS Education Excellence, Emergency Medical Institute (EMI) (2009)
  • Research Excellence, Lehigh Valley Health Network, Emergency Medicine Residency (2009)

Professional Education


  • Medical Education:Western University of Health Sciences -College of Osteopathic Medicine of the Pacific (2005) CA
  • Internship:Lehigh Valley Hospital and Health Network (2006) PA
  • Residency:Lehigh Valley Hospital and Health Network (2009) PA
  • Board Certification: Emergency Medicine, American Osteo Board of Emergency Medicine (2011)
  • MS, Stanford University, CA, Epidemiology (2011)
  • EMS Subspecialty, Stanford University Medical Center, Emergency Medical Services (2011)

Community and International Work


  • Volunteer Physician, Kathmandu, Nepal

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Volunteer Physician, Haiti

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

Research & Scholarship

Current Research and Scholarly Interests


Prehospital education, training, ultrasound and simulation.

Teaching

Graduate and Fellowship Programs


Publications

Journal Articles


  • Pitfalls in the Use of Ocular Ultrasound for Evaluation of Acute Vision Loss. journal of emergency medicine Schott, M. L., Pierog, J. E., Williams, S. R. 2013; 44 (6): 1136-1139

    Abstract

    Retinal detachment is a true medical emergency. It is a time-critical, vision-threatening disease often first evaluated in the Emergency Department (ED). Diagnosis can be extremely challenging and confused with other ocular pathology. Several entities can mimic retinal detachment, including posterior vitreous detachment and vitreous hemorrhage. Ocular ultrasound can assist the emergency physician in evaluating intraocular pathology, and it is especially useful in situations where fundoscopic examination is technically difficult or impossible. Accurate and rapid diagnosis of retinal detachment can lead to urgent consultation and increase the likelihood of timely vision-sparing treatment.This case demonstrates both the utility of ocular ultrasound in the accurate and timely diagnosis of retinal detachment and potential pitfalls in the evaluation of intraocular pathology in the ED.A 38-year-old woman presented with acute onset of bilateral visual loss that was concerning for retinal detachment. Rapid evaluation of the intraocular space was performed using bedside ocular ultrasound. Bedside ocular ultrasound correctly diagnosed retinal detachment in the right eye. Posterior vitreous detachment in the left eye was incorrectly diagnosed as retinal detachment.This case illustrates the importance of bedside ocular ultrasound and highlights some of the pitfalls that can occur when evaluating for retinal detachment. Following is a discussion regarding methods to distinguish retinal detachment from vitreous hemorrhage and posterior vitreous detachment.

    View details for DOI 10.1016/j.jemermed.2012.11.079

    View details for PubMedID 23522956

  • Comparative Evaluation of Stroke Triage Algorithms for Emergency Medical Dispatchers (MeDS): Prospective Cohort Study Protocol BMC NEUROLOGY Govindarajan, P., Ghilarducci, D., McCulloch, C., Pierog, J., Bloom, E., Johnston, C. 2011; 11

    Abstract

    Stroke is a major cause of death and leading cause of disability in the United States. To maximize a stroke patient's chances of receiving thrombolytic treatment for acute ischemic stroke, it is important to improve prehospital recognition of stroke. However, it is known from published reports that emergency medical dispatchers (EMDs) using Card 28 of the Medical Priority Dispatch System protocols recognize stroke poorly. Therefore, to improve EMD's recognition of stroke, the National Association of Emergency Medical Dispatchers recently designed a new diagnostic stroke tool (Cincinnati Stroke Scale -CSS) to be used with Card 28. The objective of this study is to determine whether the addition of CSS improves diagnostic accuracy of stroke triage.This prospective experimental study will be conducted during a one-year period in the 911 call center of Santa Clara County, CA. We will include callers aged ? 18 years with a chief complaint suggestive of stroke and second party callers (by-stander or family who are in close proximity to the patient and can administer the tool) ? 18 years of age. Life threatening calls will be excluded from the study. Card 28 questions will be administered to subjects who meet study criteria. After completion of Card 28, CSS tool will be administered to all calls. EMDs will record their initial assessment of a cerebro-vascular accident (stroke) after completion of Card 28 and their final assessment after completion of CSS. These assessments will be compared with the hospital discharge diagnosis (ICD-9 codes) recorded in the Office of Statewide Health Planning and Development (OSHPD) database after linking the EMD database and OSHPD database using probabilistic linkage. The primary analysis will compare the sensitivity of the two stroke protocols using logistic regression and generalizing estimating equations to account for clustering by EMDs. To detect a 15% difference in sensitivity between the two groups with 80% power, we will enroll a total of 370 subjects in this trial.A three week pilot study was performed which demonstrated the feasibility of implementation of the study protocol.

    View details for DOI 10.1186/1471-2377-11-14

    View details for Web of Science ID 000287532000001

    View details for PubMedID 21272365

  • Evaluation of Race and Gender Sensitivity in the American Heart Association Materials for Advanced Cardiac Life Support GENDER MEDICINE Greenberg, M. R., Pierog, J. E. 2009; 6 (4): 604-613

    Abstract

    Given the race and gender disparities in cardiac care for women and minorities, it is important to evaluate how we teach in this content area, because it may influence this bias.We assessed the American Heart Association's Advanced Cardiac Life Support (ACLS) materials, published in 2006, for examples of race and gender sensitivity that depicted culturally competent health education.Precourse materials, manuals, illustrations, case vignettes, compact discs (CDs), algorithms, and tests were evaluated for culturally competent opportunities. An opportunity was defined as each question or scenario that could have been edited to reflect race or gender. Minority status was interpreted as skin color other than white. Each individual component was counted separately. After the quantitative tally, an analysis was performed using simple percentile comparisons. Interpretations were based on these percentages.The majority of teaching opportunities (54%) did not reflect race or gender. Of 149 patient opportunities to adequately represent those at risk, none clearly represented a minority female. In the simulated cases on the provider CD, all patients were white males. The mannequin had a male haircut and an open shirt. No mannequin had female characteristics (eg, earrings, breasts, or women's clothing). None of the provider CD cases illustrated patients or mannequins with skin color other than white.The current ACLS provider and instructor materials do not maximize opportunities to illustrate vulnerable segments of the population. Future studies designed to evaluate the effect of improved representation of women and minorities in teaching models should be considered.

    View details for DOI 10.1016/j.genm.2009.11.002

    View details for Web of Science ID 000274171300010

    View details for PubMedID 20114011

  • Tricyclic antidepressant toxicity treated with massive sodium bicarbonate. American journal of emergency medicine Pierog, J. E., Kane, K. E., Kane, B. G., Donovan, J. W., Helmick, T. 2009; 27 (9): 1168 e3-7

    Abstract

    Tricyclic antidepressant (TCA) morbitity is primarily due to cardiac arrhythmias and hypotension, which become more refractory to treatment as acidosis progresses (Ann Emerg Med. 1985;14:1-9; Clin Toxicol. 2007;45:203-233; Flomenbaum N, Goldfrank L, Hoffman R, et al. Goldfrank's toxicologic emergencies. 8th ed. McGraw-Hill Companies, Inc, 2006). Early recognition and aggressive treatment are necessary for patient survival.

    View details for DOI 10.1016/j.ajem.2008.11.026

    View details for PubMedID 19931778

  • Management of isolated yew berry toxicity with sodium bicarbonate: a case report in treatment efficacy. Journal of medical toxicology : official journal of the American College of Medical Toxicology Pierog, J., Kane, B., Kane, K., Donovan, J. W. 2009; 5 (2): 84-89

    Abstract

    Taxus species are known to be toxic and may result in significant dysrhythmias. Treatment of taxus induced cardiac dysrhythmias is based largely on case reports. We describe a case of a 24-year-old male with Taxus cuspidate (yew berry) toxicity initially treated with amiodarone bolus and infusion and subsequently managed with sodium bicarbonate boluses and continuous infusion.The patient was found at home by his parents with witnessed "seizure-like"activity 2 hours after reportedly chewing and swallowing 168 yew seeds. The initial prehospital rhythm strip demonstrated ventricular tachycardia (VT); the patient was hypotensive with fluctuating levels of alertness. Prehospital cardioversion was attempted without success. Staff at the local presenting emergency department (ED) consulted toxicology for management of the presumed yew berry ingestion, complicated by cardiac dysrhythmias and mental status change with seizure. Amiodarone 300-mg IV and diazepam 5-mg IV were given. Cardioversion was attempted 4 times without change in the wide complex tachycardia, presumed to be VT, at a rate of 166. An amiodarone drip at 1 mg/min was initiated. The patient was transferred to an intensive care unit (ICU) at a regional toxicology center. On arrival to the toxicology center the patient was alert and verbally appropriate without complaints. Initial heart rate was 76 and regular with premature ventricular contractions (PVCs). A wide complex tachycardia associated with hypotension recurred; however, normal mental status was maintained. A bolus of 100 mEq of sodium bicarbonate (NaHCO3) was given intravenously followed by sodium bicarbonate infusion at 37.5 mEq/hr. The amiodarone drip was discontinued. Subsequent electrocardiograms (EKG's) revealed a prolonged, but steadily narrowing QRS complex. Ultimately, the QRS complex closed to 92 ms, with a rate of 94, PR 154 and a QT/QTc of 390/487.This case describes successful treatment of an isolated Taxus cuspidate (yew berry) ingestion with significant toxicity initially with amiodarone bolus and infusion. Due to lack of significant change in telemetry recordings with amiodarone, treatment with sodium bicarbonate bolus and infusion was initiated. While the QRS narrowed significantly temporally related to the bicarbonate, it is difficult to determine if correction of the cardiac dysrhythmias was solely due to the sodium bicarbonate, or the synergism of sodium bicarbonate and amiodarone, or possibly spontaneous improvement due to taxine clearance. One should use caution while drawing conclusions from a single case; however, based on the clinical improvement of this patient, both with EKG recordings and vital signs, this report would suggest that isolated Taxus cuspidate ingestion from yew berry plants can be treated with sodium bicarbonate.

    View details for PubMedID 19415594

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