Answer:
Thank you for the question. While this may have been the direction previously delivered by the base hospital program or at the college level, the NWRPCP would like to provide the following clarification:
If Paramedics are considering the use of Nitroglycerine SL under either Medical Directive, there is no need to remove the patients Nitroglycerin transdermal patch prior to the administration.
The delivery of transdermal Nitroglycerine is generally quite slow with the rate of absorption occurring over several hours. This poses a minimal risk for any synergistic effect during the co-administration with sublingual nitrates. As always, we ask that Paramedics continue to use their clinical judgement when treating with symptom relief medications and ensure that their patients are safely within the parameters of the associated medical directive.