Question: In which instance should a transdermal patch be removed in the pre-hospital setting? Example 1: Hypotensive patient with a Nitro patch on. Example 2: VSA with a narcotic patch on. Example 3: Suspected OD with a narcotic patch on (or several).
This is a fantastic question! We have all seen patients in the prehospital as well as ED environment who have similar presentations to what you are describing. The fortunate thing is that for many (not all) paramedic transports, the transport time is relatively short. This can be balanced by the fact that the dosing from the cutaneous patches is comparatively slow and gradual.
That being said, it would be ideal if patches of meds which can alter level of consciousness (such as fentanyl) and/or alter hemodynamics (such as NTG) are removed with unstable patients as you describe.