Lethal asphyxial entrapment between bedrails and mattresses is a well-recognized clinical event although there are few descriptions of autopsy findings. This convenience sample series of 29 deaths shows the infrequency of petechiae and laryngeal crush injuries and subtlety of soft-tissue trauma findings in such cases. Petechiae, plethora, and venous congestion may be noted in extremities that are pinned by rails in a manner that obstructs venous return. Medical examiners must mainly rely on eyewitness descriptions of the how the person was found and try to correlate this position with scanty signs of trauma.