Subcutaneous emphysema, a known complication of tracheobronchial injury (TBI), is usually a self-limiting condition, but occasionally, a massive one can become life-threatening. We present a patient with TBI who developed massive subcutaneous emphysema with bilateral pneumothorax causing hemodynamic instability. Upon arrival to the hospital, the patient required emergent intubation for impending respiratory collapse. Bilateral thoracostomy tubes were inserted, resulting in hemodynamic improvement. Emergent CT thorax showed a tracheal-oesophageal injury just distal to the cuff of the endotracheal tube (ETT) at the level of the third thoracic vertebra (T3). Despite surgical repair and intensive care, the patient succumbed after a week in ICU due to ventilatory failure. This case report highlights the importance of the initial management of TBI requiring rapid identification and airway management.