My worse situation was similiar to yours shoelace. I had a pt who'd already ruled in once for an MI, was waiting for a CABG. He had an IWMI. Anyway, he'd a IABP for a few days but they pulled it that afternoon because they felt he was doing fine without it. Within a half hr he began having major CP...EKG showing the worse ST elevation I have ever seen. Paged the docs, started a NTG gtt, got another EKG, same thing, not any better, man is vomiting all night long. The resident said flat out she doesn't knwo what to do, I beg her to call the fellow or the attending, fellow says just give him some Ativan. Right ...like that is gonna fix ST elevation. The resident didn;t even want to send enzymes, but I sent them anyway hoping to prove to her that something BAD was going on. He came back with a Troponin of over 150.
Anyway, this song and dance went on all night long. I am feeling so bad for this man and keep on telling the docs, he needs to go to the cath lab....this isnt under control. He keeps on telling me this is the worse he has ever felt in his life. He looked just like a deer in headlights.
Problem was it was Christmas Eve...they didn't want to bother the attending, despite all the obvious signs that his man was not getting better.
That morning we intubated him bc he went from 2LNC to a 100% NRB and his sats started dropping on that. The put the balloon pump back in that morning. When CT Surgery came to round on him the refused to do the CABG for the next few days because he got unstable that night. Over the course of a few days, he gotten sicker, and sicker, spiked temps and got septic. Of course then CT Surgery really refused.
About a week later after all of this, the family decided to withdraw. Fortunately they were able to extubate him and he could talk to his family, and he said that they were making the right decision, etc. Still was the saddest thing ever and as I am writing this tears are still coming to my eyes.