Positional asphyxia (AP) is a fatal condition arising because of the adoption of particular body positions, causing mechanical interference. Consequences are important alveolar hypoventilation and cardiac hyperexcitability due to respiratory acidosis in combination with extensive liberation of catecholamine occurring in attracted individuals sustaining physical restrain. This syndrome can occur in various circumstances and is mostly observed in situations with physical restraint and in combination with excited delirium (ED). The diagnosis is essentially based on three criteria: body position obstructing normal breathable air exchange, impossibility to move to another position and exclusion of other causes of natural or violent death.