Bruit and thrill are important physical signs observed during patient examinations. A bruit is an abnormal whooshing or swishing sound heard during auscultation. A thrill is a vibration felt by touch. Both indicate underlying physiological conditions, particularly those involving blood flow.
Understanding Bruit and Thrill
Bruit and thrill are physical manifestations of turbulent blood flow within the circulatory system. A bruit is an audible vascular sound, often a whooshing sound, caused by blood flowing abnormally through an artery. This turbulence can arise from a narrowing of a vessel, known as stenosis, or from an abnormal connection between an artery and a vein, such as an arteriovenous (AV) fistula. When blood encounters a narrowed section or an irregular pathway, its smooth, laminar flow becomes chaotic, creating vibrations that produce the characteristic sound.
A thrill is the palpable counterpart to a bruit, a vibration felt on the skin over an area of turbulent blood flow. It is often described as a buzzing or purring sensation. While a bruit is detected using a stethoscope through auscultation, a thrill is identified by palpation. Both signs are significant because they can indicate vascular abnormalities, such as atherosclerotic plaque causing arterial narrowing, aneurysms (weakened, ballooned vessels), or arteriovenous malformations. However, a bruit and thrill are normal findings over a functioning arteriovenous fistula created for hemodialysis, as the surgical connection intentionally creates turbulent, high-pressure flow.
Key Elements of Documentation
Documenting bruit and thrill is essential for accurate medical records and patient care. When a bruit or thrill is identified, healthcare providers record specific details to provide a complete picture. This includes the exact anatomical location where detected, such as “right carotid artery” or “left forearm, distal to AV fistula.” Precision helps other healthcare providers understand the context and track changes over time.
Beyond location, the quality and intensity of the bruit or thrill are noted. For bruits, terms like “soft,” “moderate,” or “loud” describe intensity, while “continuous,” “systolic,” or “diastolic” indicate timing relative to the cardiac cycle. A continuous bruit or one extending into diastole can suggest significant pathology. For thrills, descriptors might include whether it is continuous or intermittent, and its perceived strength. Any associated findings, such as changes in skin temperature, color, or swelling, are also documented, as these provide additional context about the underlying vascular condition.
The Importance of Accurate Records
Accurate documentation of bruit and thrill is central to high-quality patient care. Accurate records enhance communication among all members of the healthcare team, ensuring consistent and comprehensive information. This clear communication helps coordinate care, especially when multiple specialists are involved, and reduces misunderstandings or errors in treatment plans.
Documentation also facilitates monitoring a patient’s condition over time. By recording the characteristics of a bruit or thrill, providers can track whether a vascular abnormality is worsening, improving, or stable. This longitudinal record supports informed clinical decisions, allowing for timely adjustments to treatment protocols and proactive interventions. Ultimately, documentation contributes to patient safety by providing a reliable history, foundational for optimal outcomes and continuity of care across different healthcare settings.