[Recognising positional asphyxia: not always the cause of death in victims in an unusual position]

Deceased individuals may be found in a position that raises the question of whether or not the individual died from being in that position. We describe 3 victims of 35, 84 and 54 years of age, respectively. All were found in an unusual position that may have impeded breathing. Breathing may be impaired by compression of the thoracic wall or by extrathoracic airway obstruction caused by the position. Reduced independence, with causes varying from dementia to inebriation, is a risk factor for positional asphyxia. Restraining a person in the so-called "hogtie position" does not lead to positional asphyxia. Positional asphyxiation in individuals dying in the hogtie position must not be confused with excited delirium syndrome (EDS). On the other hand, the diagnosis of positional asphyxia must be seriously considered in deceased individuals found in a position that may impede breathing.