[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Forensic medicine](https://durgical.com/en/forensic-medicine/) › [Asphyxia and physical agents](https://durgical.com/en/forensic-medicine/areas/asphyxia-physical/) › Traumatic and positional asphyxia # Traumatic and positional asphyxia - Finding In traumatic asphyxia a weight crushes the chest; in positional asphyxia the body's posture stops breathing and the person cannot escape it. Updated Nov 5, 2026 ## Key points - Traumatic asphyxia: violet congestion of the face, neck and upper chest, petechiae and conjunctival haemorrhages, with a sharp boundary. - Positional asphyxia: a posture that prevents breathing, inability to escape it and exclusion of other causes. - Alcohol or drug intoxication is a common factor in positional asphyxia. - Autopsy findings are non-specific: the scene and the circumstances are decisive. - Death during restraint or in custody: independent investigation and a full autopsy. ## What it is Asphyxia from chest compression prevents breathing movements. In traumatic asphyxia a heavy weight crushes the chest or abdomen: a vehicle, a collapse or a crowd crush. It causes intense congestion of the face, neck and upper chest, with petechiae and conjunctival haemorrhages, sometimes with a sharp boundary. In positional asphyxia the body's posture (head down, neck sharply flexed, body trapped) prevents breathing and the person cannot get out of it, often because of intoxication. Face-down restraint with weight on the back, in custody or during physical restraint, is a setting that demands an independent investigation. ## How to tell it apart - Versus strangulation: the congestion also covers the upper chest and there are no neck marks. - Versus livor in a head-down body: livor appears after death and follows gravity. - Versus sudden natural death: look for the natural cause; if present, judge whether the posture contributed. - Criteria for positional asphyxia: a posture that prevents breathing, inability to change it and exclusion of other causes. ## How to recognise it - Intense congestion and cyanosis of the head, neck and upper chest, with a sharp boundary. - Facial petechiae and subconjunctival haemorrhages. - Pale areas where clothing or an object pressed on the skin. - Chest and abdominal injuries depending on the force: rib fractures, contusions. - In positional asphyxia: an abnormal posture documented at the scene and few or no specific internal findings. ## How it forms - Chest compression prevents lung expansion; venous pressure rises and blood backs up into the head and neck. - In positional asphyxia, neck flexion or a head-down position obstructs the airway or tires the breathing muscles. - In face-down restraint, weight on the back and prior agitation worsen ventilation. ## Next step: what to do and document - Document and photograph the body's position, the objects trapping it and the spread of congestion before moving it. - Request toxicology with a chain of custody: intoxication is common in positional asphyxia. - In a crush survivor, describe petechiae, conjunctival haemorrhages and chest injuries, and refer for trauma assessment. - In every death during restraint or in custody: notify the Fiscalía at once and secure a full medico-legal autopsy. - State in the report which circumstances are on record and which are missing; do not conclude without the scene. ## Common mistakes - Attributing a death to posture without ruling out intoxication and natural disease. - Moving the body without documenting its exact position at the scene. - Confusing livor in a head-down body with vital congestion. - Not requesting the records of the restraint or custody (videos, times, who intervened). ## Test yourself Think of the answer, then tap the question to see it. ## Which external finding characterises traumatic asphyxia? Intense violet congestion of the face, neck and upper chest, with petechiae, conjunctival haemorrhages and a sharp boundary. ## What are the criteria for diagnosing positional asphyxia? A posture that prevents breathing, inability to get out of it and exclusion of other causes of death. ## Which factor is often found in victims of positional asphyxia? Alcohol or drug intoxication, which keeps the person from changing position. ## What does a death during restraint in custody require? An independent investigation with a full medico-legal autopsy, as the Minnesota Protocol recommends. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/forensic-medicine/traumatic-and-positional-asphyxia/) ## Connections ## Related 5 - [Mechanical asphyxia: types and the general signs](https://durgical.com/en/forensic-medicine/mechanical-asphyxia-types-and-the-general-signs/) - [Road traffic injuries: pedestrians, drivers and riders](https://durgical.com/en/forensic-medicine/road-traffic-injuries-pedestrians-drivers-and-riders/) - [Forensic toxicology: which samples and how](https://durgical.com/en/forensic-medicine/forensic-toxicology-which-samples-and-how/) - [The death scene: inspección técnica a cadáver (levantamiento)](https://durgical.com/en/forensic-medicine/the-death-scene-inspeccion-tecnica-a-cadaver/) - [The medico-legal autopsy: when it is mandatory in Colombia](https://durgical.com/en/forensic-medicine/the-medico-legal-autopsy-when-it-is-mandatory-in-colombia/) ## Related conditions 1 - [Acute alcohol (ethanol) intoxication](https://durgical.com/en/conditions/acute-alcohol-intoxication/) [← All of forensic medicine](https://durgical.com/en/forensic-medicine/) Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority. Sources: [Sudden deaths from positional asphyxia: a case report](https://pmc.ncbi.nlm.nih.gov/articles/PMC6023692/) (Medicine (Baltimore), PubMed Central, 2018); [The Minnesota Protocol on the Investigation of Potentially Unlawful Death (2016)](https://www.ohchr.org/sites/default/files/Documents/Publications/MinnesotaProtocol.pdf) (Office of the United Nations High Commissioner for Human Rights, 2017). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/forensic-medicine/traumatic-and-positional-asphyxia/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/forensic-medicine/traumatic-and-positional-asphyxia/