If you decide to test your luck and compete in
Squid Game (prize money in eyes)– you better be ready to lose it all.
The majority of the 456 competitors that entered Squid Game had their ticket to the
afterlife punched in one of two ways: a bullet to the vital organs (most often the head),
or a fall from height onto a concrete surface.
Both of these methods are extremely effective means of elimination…
If you’re into eliminating hundreds of people just to:
But today we’re going to focus on some more nuanced injuries that we witnessed in the series,
analyzing the following scenes from a medical perspective.
Ironically, our first couple of examples happen in the city of Seoul, entirely outside
the Squid Game grounds. Frustrated that his employer will not pay the wages owed to him,
Ali attempts to grab an envelope full of cash from inside his employer's pocket.
The altercation that follows leaves them both off balance and well -
it’s safe to say that a factory is not the ideal place for a shoving match.
The human body doesn’t fare well against industrial machinery.
An injury to the hand such as this would require immediate medical attention. He can count himself
lucky that the failsafe mechanism stopped the machine before the entire hand or arm was crushed.
Industrial injuries are often quite serious as a result of the nature of the machinery used.
These machines are designed to automate physical tasks that are usually quite onerous. As a result,
they are designed to exert forces that would otherwise prove quite difficult for
a human to do. This equates to high pressures, extreme temperatures, or extremely heavy loads.
Presses are known to exert forces in the several ton range. So it should come as no surprise that
when it comes to person versus industrial machine, the machine ALWAYS wins. So much so, that it is
common for industrial machinery injuries to cause disfigurement as a result of the havoc
that these machines wreck on workers, or those who should become entangled with them. Amputations
as a result of entrapment in an industrial machine and the ensuing injury is common.
Here, the employer’s hand becomes trapped in a rolling press. Immediately, his hand is caught
by the rollers and starts to feed in between them. Against a several ton roller press,
his fingers don’t even stand a chance. They are instantly crushed, or perhaps I should say
popped like a balloon, because that is what happens as his fingers are drawn in. From
a medical perspective, this would be an extreme crush injury, where both the soft tissue and bone
are exposed to extremely high pressures. Extensive fracturing or comminution of the bones of the
fingers would occur. This would be associated with extensive crushing of the muscle tissue with
damage to the nerves and blood vessels within. This injury would be quite bad and likely not
even repairable or salvageable. The soft tissues would likely die from the extensive cellular
damage to the muscle fibres. As is usual with crush injuries, this would occur gradually over a
period of days and maybe even weeks. In addition, it would quite likely become infected as a result
of the open nature of the injury and the extensive damage to the skin tissue. In fact, the employer,
once treated, would be highly susceptible to both cellulitis,
an infection of the skin and underlying tissue, as well as osteomyelitis, an infection of the bone.
To be honest, it might be better just to amputate the fingers right away
as the recovery from this injury might be quite protracted with serial surgeries.
Orthopedic fixation of his fingers would be extremely difficult and might just require
a “bag of bones” approach, where the individual bones are not fixated,
but the body segment is simply immobilized hoping for the best. Not to mention that
several revision surgeries would likely be needed to debride away dying tissue and
clean the evolving wounds. And just because everyone likes to carry around a fanny pack
filled with an intravenous pump and intravenous antibiotics 24/7, he would also likely need a six
to eight week course of antibiotics to treat the infections that would likely occur. Stylish!
In this vicious knife attack,
gangster Jang Deok-su lashes out at one of his underlings who has just betrayed him.
Obviously Jang Deok-su goes above and beyond here,
ensuring that his former underling does not live to see another day– but let’s pretend
that the underling dodges the final blow to the neck and escapes with his life. This is what he
could expect from knife wounds to the outside of the knee, base of the spine and abdomen.
Let’s face it. Getting stabbed is not fun and it is not something you want for Christmas. Here,
Jang Deok-su stabs his henchmen repeatedly with a fixed blade knife. First, he stabs the henchmen
in the lateral side of the thigh, just above the knee. He inserts most of the blade, which looks
to be between 5-6 inches in length, into the outer thigh. Fortunately for the henchmen, there really
isn’t much of concern in that area. Don’t get me wrong. I am not running out to get stabbed in the
side of the thigh, but in that location, you have the iliotibial band under which lie the vastus
lateralis muscle and the femur itself. There are not major blood vessels in this area. While being
stabbed in this area may not feel pleasant, it fortunately won’t kill you, leaving the henchmen
alive to attempt to escape…rather slowly, since your leg won’t work that well with a 5 inch blade
sticking out of it. Leaving him susceptible to being stabbed again in the low back.
Now this one is a bit more worrisome. Generally speaking, being stabbed in an extremity is safer
than being stabbed centrally in the body because all of the important stuff, you know, your organs
that live there. In the back, the kidneys are exposed without any protection. Since they lie
in the retroperitoneal space, or the space behind the abdomen, they are susceptible to being stuck
by long pointy things. Being stabbed in the low back is a good way to lacerate a kidney,
it’s vasculature supplying it, or the ureters connecting them to the bladder. More importantly,
the major vessels traveling to and from the heart, namely the aorta, and the vena cava lie
immediately in front of the spinal column along the back of the retroperitoneum.
They are located well within 5 inches of the surface of the skin and they like being punctured
by point stuff even less than do the kidneys. A kidney laceration won’t immediately kill you,
but a laceration of the major vessels will empty your blood volume into your abdomen really, really
quickly. If one or both of them were lacerated, and medical attention were not immediately
rendered, this would quickly prove to be fatal. Not that it would really matter because Jang
Deok-su then rolls the henchmen over and stabs him several times in the abdomen in quick succession.
This is bad news. Your abdomen is jam packed full of gastrointestinal organs,
namely the stomach, the liver, the and the large and small bowel. Several of these organs are
filled with food in various stages of dissection. In the body, food does well inside the GI tract,
but does really, really poorly outside of it, while still inside of the body.
Laceration of any of these organs with a knife will offer a pathway for food contents to spill
out of the GI tract, into the periotoneum. This is a potential source of peritoneal contamination,
either with food contents and digestive enzymes, or with poop in various stages of formation and
bacteria. Neither of these is good for you and both require immediate medical attention,
namely a diagnostic laparotomy where they open up your belly and “run the bowel”,
looking for evidence of injury. Of course, if you find food or poop in the peritoneal cavity,
that needs to be removed and the peritoneal cavity thoroughly cleaned. Of course, since
the bowel was dirty at the time of laceration, you can’t just repair the laceration and then close
it up. That would be sure to fail as a result of serious infection. Any bowel surgery in this
context is going to result in a temporary stoma of some sort, where the bowel is brought out of
the belly through the skin. The stoma would empty into a bag and would be kept in place until the
intra-abdominal injuries healed. But I don’t think that the henchmen will need to worry about this
as Jang Deok-su finishes off the henchmen with a stab to the left side of the chest. Suffice it
to say that when you stick the heart with a knife, it has a really hard time pumping blood around the
body. And in case you were wondering, that is bad. You need the heart. Always. Without exception.
Finally we arrive on Squid Games island, as the competitors learn that there is no safe space
once the games have begun - not even the players quarters / their beds. When the lights go off,
the host locks the doors and a riot breaks out.
Here we see Jang Deok-su attacking fellow competitor Sae-byeok in an
attempt to remove her from the competition.
He slams her elbow against a metal bed frame to make her drop her knife, then slams her
body into a brick wall before strangling her. Bashing the back of your arm against a metal
post might cause you to drop an object held in your hand as a result of the overall pain.
In your forearm, there is not a direct connection between the extensor muscles
on the back of the forearm, and the flexor muscles on the front of the forearm. However,
pain is a serious motivator and it is quite possible the pain experieinced in the back of the
forearm was enough to encourage Sae-byeok to drop the knife. In pushing her up against the wall,
it is possible that she might crack the back of her head against the wall, which could result
if a closed head injury and potentially even a fracture at the back of her skull.
Luckily she knows the universal “get the heck off of me”
input compatible with the majority of human males, and manages to escape.
Elsewhere, other competitors are casually snapping each other's necks and beating
each other to a pulp with broken pieces of their metal bed frames.
Getting pummeled with steel pipes could
be quite problematic depending on where you got hit with the pipe.
Getting hit in the head is definitely a problem and could potentially end poorly.
But so might getting struck in the arm, particularly if you try to defend yourself.
This is the mechanism of injury associated with a closed transverse fracture of the ulna,
otherwise known as a Nightstick Fracture. It is a common injury in alleged criminals
who were struck by officer’s batons, hence the name Nightstick Fracture. Typically,
these fractures are simple transverse fractures of the mid ulnar shaft. Usually,
there is little fragmentation or comminution and there is moderate displacement. They are
typically treated with open reduction and internal fixation of the ulnar shaft with plate and screw
fixation. But something tells me that they are not really worried about this at the Squid Game.
When you might get offed at the next moment for any number of reasons,
a little Nightstick action is the least of your concerns.
Our final scene pits childhood friends Cho Sang-woo and Seong Gi-hun against each other
in a heartbreaking brawl. Gi-hun is the first to draw blood cutting the outside of Sang-woo’s
closed fist, then slashing him across the cheek. A facial laceration such as that shown here would
cause a laceration of the buccinator muscle on the outside of the cheek. The buccinator is a
flat muscle that lies between the maxilla and the mandible on the side of the face.
It forms the lateral wall of the oral cavity and it assists with mastication or chewing.
Fortunately, Seong Gi-hun is not doing much eating here so he is not overly affected by this injury.
The men exchange several blows, then Sang-woo then retaliates with an eye gouge sticking his thumb
in Gi-huns eye.
Jamming one’s finger into someone’s eye is probably a great way to cause major
damage to the eye. This could cause a whole heap of injuries ranging from
abrasions or lacerations of the eyelid, abrasions or laceration of the cornea,
to even ruptures of the globe. While external abrasions and lacerations are of minimal concern,
corneal abrasions and lacerations are extremely painful and make seeing out of the injured eye
really, really difficult. Which could be problem in the middle of a fight when
you are trying to watch the guy with the pointy thing trying to stick you.
As these guys go back and forth, it’s obvious that they aren’t fighters. And in a way,
it seems to add to the drama of the scene. These are regular men trying desperately to survive.
In a desperate brawl such as this we can expect:
More injuries from them slip, sliding, and falling rather than from fighting each other. Although
desperately engaged in hand-to-hand combat, their lack of experience as fighters prevents
them from doing significant damage to each other as they roll around in this exchange.
They might be battered and bruised by this portion of the melee,
but they would not suffer any significant injuries here.
As our clothing-soaked combatants begin to tire, Sang-woo delivers two significant blows with the
knife to the thigh and abdomen of Gi-hun. He then performs his best imitation of Leonidus from 300,
connecting the bottom of his foot to Gi-hun’s face.
Stab wounds to the posterior thigh would be more problematic
than those to the side of the thigh. The major nerve of the posterior leg,
the sciatic nerve, travels down the back of the thigh surrounded by muscle tissue.
It is quite possible that it could be injured by such a stab wound. Minor injuries to the sciatic
nerve could result in dysesthesias or altered sensation in areas supplied by the sciatic nerve.
This could include numbness, tingling, or burning in the distributions of the sciatic nerve on the
lateral leg and over the foot. If the nerve were injured more severely or even transected,
motor function of muscles that receive innervation from branches of the sciatic nerve would be lost,
including the posterior thigh muscles, and the muscles of the leg and foot.
I’ve already talked about being stabbed in the abdomen, and I think that we have established that
it is no bueno. Particularly in the left lower quadrant of the abdomen. Pure poop and peritoneal
soiling. This results in a surgical emergency called an acute abdomen. Open it up or die.
Sang-woo’s next attack is perhaps the most poignant moment in this scene. He attempts
to deliver a killing blow, and an exhausted Gi-hun takes the blade directly through his
hand in order to save himself; a hail mary attack met with a hail mary defense. Then
Gi-hun retaliates by biting a chunk out of Sang-woo’s ankle. The desperation is palpable.
Although painful, a stab wound to the palm might not actually result in that serious
injury. I am not saying that it is walk in the park, but there is a good chance that the blade
would be oriented parallel to the rays, or bones of the hand. There is a good chance that the blade
would pass right between the bones causing injury only to the intrinsic muscles of the hand. As the
blade would be running in the same direction as the extensor tendons on the back of the hand,
and the flexor tendons on the palm of the hand, they might not be impacted by the stab wound at
all. There is a possibility that the blade would pierce the vascular arch of the hand,
the superficial palmar arch. However, since the hand has significant collateral circulation,
this would be more messy that it would be a problem for the hand. Of course, it is always
difficult to grasp with your hand it you have a knife sticking out of it, so there’s that.
With his very last ounce of strength, Gi-hun subdues his opponent with a barrage of punches.
He then removes the knife (which has been stuck in his hand the whole time),
and decides to show mercy. There is no telling if Sang-woo would have been allowed to survive,
had he accepted Gi-hun’s truce.
Being stabbed in the side of the neck with a 5 inch blade is going to be
very problematic. Although there are possibly muscular planes between which the knife would
travel without piercing important structures, it would be incredibly lucky to be able to do this
successfully. Most importantly, the blade might penetrate the blood vessels of the neck, either
the carotid arteries taking blood to the head, or the jugular veins taking blood away from the head.
Obviously, lacerating the carotid would be worse, but neither injury is a good thing.
Both would lead to dangerous hemorrahage from the neck, one rather precipitously,
the other more slowly. Sandwiched between these vessels is the vagus nerve, main autonomic nerve
of the body supplying parasympathetic fibers to all the organs and to some skeletal muscles.
Injury to this nerve would impact a number of tasks such as heart rate, GI motility, sweating,
and the gag reflex. This would not be good since the blade would likely also penetrate the larynx,
or throat, and possibly even the esophagus. Without a gag reflex, there would be no
protection against blood pooling in the back of the throat which eventually would result in
aspiration. Not a fun way to go out…drowning on your own blood. It would be better to be
taken out during the Red Light Green Light. But I guess that’s what the game is all about. You
never know when you are going to win or when you will lose, but either way, the stakes are high.
While watching Squid Game I was very surprised by the sheer amount of violence. But the extreme
nature of the show is what grabs your attention and makes you think… Squid Game players are
everyday people, with relatable problems, desperately trying to gain financial freedom
in a world where the odds are stacked against them. The creator is definitely saying something
about the world we live in– And from a medical perspective I can see what he may be getting at.
I regularly treat people for whom health is an afterthought. While you’re running the rat race,
it is routine to sacrifice diet, sleep, stress management and exercise. In the real world,
the example may be less extreme, but is our world equipped with the right institutions,
programs and support systems to foster healthy individuals? Could you be sacrificing
some aspect of your health in order to make a living? What changes do we need to make?