Dr.Hashim aln3mi

Internal Medicine Residency Program
Always learning | Continuous growth
Medicine • Clinical thinking
🇸🇦 #SaudiMedTwitter

[Dr.Hashim aln3mi @ALn3my]

@Saudia_Care

Hello, I urgently need an official letter confirming the disruption/cancellation of my flight SV1662 on 25 July 2026. I need this document to submit to AROYA Cruises regarding my missed embarkation. I have my booking reference and supporting documents ready. Could you please assist me?

[Dr.Hashim aln3mi @ALn3my]

What. Do your interpretation for this Echo?
🤔

#CardioTwitter
#MedTwitter
#FOAMed

[Dr.Hashim aln3mi @ALn3my]

في STEMI:
👉 التشخيص = ECG + clinical picture
👉 لا تنتظر التروبونين

Time is myocardium
📌 في suspected ACS:

👉 أعد التروبونين بعد 2–4 ساعات
(Serial troponin is essential 🔁)

[Dr.Hashim aln3mi @ALn3my]

هذا مريض اليوم في الطوارئ:

Central chest pain for one hour ⏱️
Troponin = 13 ng/L (0–14 طبيعي)

وهذا ECG👇
What’s the diagnosis?

#MedTwitter #Cardiology #ECG

[Dr.Hashim aln3mi @ALn3my]

📊 Timeline of troponin in MI:

• 0–2 hours → often still normal
• 3–6 hours → starts to rise
• 6–12 hours → clearly elevated
• ~24 hours → peak

👉 إذا المريض جاي بدري ممكن يكون التروبونين طبيعي

💡 السبب:
Insufficient myocardial necrosis yet
(ما صار damage كافي)

[Dr.Hashim aln3mi @ALn3my]

Coronary Angiograghy show

LAD = 100% occluded (mid segment) 🔥

طيب كيف Troponin طبيعي؟ 🤔

[Dr.Hashim aln3mi @ALn3my]

❓Clinical Question:
A patient presents with dyspnea.
CXR shows this finding 👇

👉 What is the diagnosis?
👉 What is the name of this sign?

#MedTwitter #ClinicalCase #ChestXray #SpotDiagnosis #Radiology #InternalMedicine #Cardiology #MedicalEducation #ClinicalPearls #FOAMed

[Dr.Hashim aln3mi @ALn3my]

Proud to share our work on cancer trends in Southern Saudi Arabia is now published 🙏🌹

Grateful to Dr. @AAlloghbi and the team for their guidance and collaboration.

#MedTwitter #AcademicMedicine #ResearchJourney

[Dr.Hashim aln3mi @ALn3my]

Pleural Effusion: CXR vs Ultrasound 🫁

Not all effusions are visible on CXR.

🔍 CXR
•Needs ~200–300 mL to detect
•Look for: blunted costophrenic angle + meniscus sign
•Can miss small effusions (especially in ICU patients)

🟡 Ultrasound
•Detects as little as 5–50 mL 🔥
•Shows anechoic fluid + septations
•Essential before thoracentesis

💡 Take-home:
If you rely only on CXR → you will miss pleural effusions.

#MedTwitter #FOAMed #POCUS #InternalMedicine #ICU #Pulmonology #Radiology

[Dr.Hashim aln3mi @ALn3my]

🚨 Back Pain Red Flags = MRI (Don’t Miss These)

Not every back pain needs imaging ❌
But missing a red flag = serious harm ⚠️

🔴 Order MRI if:
• History of cancer + new back pain
• Fever / IV drug use / infection signs
• Severe or progressive neurological deficit
• Saddle anesthesia or bowel/bladder dysfunction
• Unexplained weight loss
• Immunocompromised

🟡 Consider MRI:
• Persistent pain >6 weeks despite treatment

🟢 No MRI:
• Acute back pain (<6 weeks) with NO red flags

💡 Treat first. Image only when it matters.

#MedTwitter #InternalMedicine #Radiology #BackPain #FOAMe

[Dr.Hashim aln3mi @ALn3my]

When to do ERCP vs MRCP in suspected CBD stones

Rule of thumb:

🟥 High probability → ERCP
• CBD stone on imaging
• Ascending cholangitis
• Bilirubin >4 + dilated CBD

🟨 Intermediate probability → MRCP / EUS
• Abnormal LFT
• Age >55
• Dilated CBD

🟩 Low probability → Cholecystectomy

💡 Remember:
MRCP = diagnosis
ERCP = treatment

#MedTwitter #FOAMed #InternalMedicine #Gastroenterology

[Dr.Hashim aln3mi @ALn3my]

@md1talk Pneumothorax Rt lung

[Dr.Hashim aln3mi @ALn3my]

هذا الكتاب ساعدني كثير في تطوير مهارتي في قراءة ECG.

كنت أقرأ يوميًا 10–20 ECG لمدة شهر كامل
والفرق كان واضح جدًا في سرعة التفسير والتفكير السريري.

التعلم الحقيقي في ECG يأتي من رؤية أكبر عدد ممكن من الحالات وليس فقط قراءة النظريات.

📘 الكتاب: 150 ECG Problems – John Hampton

📥 الرابط:
(https://t.co/uV6R9qOLlH)

#ECG
#Cardiology
#MedTwitter
#FOAMed
#InternalMedicine
#MedicalEducation

[Dr.Hashim aln3mi @ALn3my]

Right-sided heart failure is usually the result of 3 main mechanisms:

🔴 Pressure overload
• Pulmonary hypertension
• Pulmonary embolism

🔵 Volume overload
• Tricuspid regurgitation
• Intracardiac shunts

🟢 Myocardial disease
• RV infarction
• ARVC

💡 MC:Left-sided HF

[Dr.Hashim aln3mi @ALn3my]

Thrombocytosis = Platelets &gt;450,000 /µL

Causes can be divided into:

🧬 Primary (Myeloproliferative)
🔥 Secondary (Reactive)

A simple summary 👇

#MedTwitter

[Dr.Hashim aln3mi @ALn3my]

Interesting finding on echo today 👀

What do you think this structure represents?

#MedTwitter #Cardiology #Echo

[Dr.Hashim aln3mi @ALn3my]

افضل صورة ارجع لها للAntibiotics 🦠💊