This chapter discusses the diagnosis, evaluation and management of soft tissue injury: crush injury, arterial injury, and open fractures. The crush syndrome comprises the systemic manifestations that arise as a result of a crush injury once the external force is removed. Arterial injury can lead to hypotension if the hemorrhage is not addressed aggressively with source control and resuscitation with fluids. The mangled extremity severity score (MESS) is the most widely validated classification system of the lower extremity when evaluating the severity of open fractures. Limb viability is related to vascular status, patient age, duration of ischemia, and absorbed energy. Hypovolemic shock is the leading cause of death after soft tissue injury. Placement of two large-bore IVs and aggressive fluid resuscitation is necessary in the hypotensive individual. Cardiac arrhythmias and cardiac arrest contribute to a large percentage of early deaths in crush injury patients.