The violence is quite graphic and it racks up an extremely high body count.
When the movie begins, we see real-life documentary footage of Burmese Soldiers killing innocent people, mutilated corpses being buried, Land-Mine injuries, Disembodied heads etc.
At one scene in the beginning, Burmese Soldiers toss land-mines into a swamp and force civilians to run through it. The overall point is that the soldiers want to see who gets killed for the purposes of gambling. One man explodes into a mist of blood, and the rest are gunned down. This scene is not intense, but it is very savage and disturbing.
We see a village raided by Burmese Soldiers. They execute four of the villagers (with some blood shown) and they steal all the children from the families to recruit them as soldiers. The leader threatens "to cut out their tongues" and "feed them they're intestines" if they go against him.
Rambo, and a group of missionaries attempt to enter Burma by boat and they are attacked by Pirates. The pirates hold them all at gunpoint and demand that Sarah be handed over to them. Rambo shoots them all with a handgun (a bit of blood is shown) and then he shoots the last one in the head. Blood splatters all over the camera.
After Rambo drops off the Missionaries, he disposes of the pirates bodies by parking their boat in a pond and pouring gasoline all over it. The gasoline is shown mixing with the blood puddles and then Rambo tosses a lighter onto the boat. The boat explodes into flames.
There is a prolonged scene where the Burmese Military massacres an entire village with mortars and assault rifles and flame throwers. Buildings are shown on fire, some houses blow up and even civilians are shown completely exploding into gory pieces which splatter all over the place. After this, the ground forces move in and shoot down all the villagers with much blood splatter. Some children are shot/executed at close range, and a young boy is held down by a soldier's boot and stabbed in the stomach with some blood shown. Some villagers are (briefly) shown getting their limbs amputated with a machete and they scream in agony. A toddler is separated from his mother and a soldier throws him into a burning building. Some villagers are set on fire with a flame thrower. The scene ends with a large .50 caliber machine gun driving by on a truck and shooting them all down with much blood visible. This entire scene is extremely violent, emotional and sickening.
There is a scene where Rambo has a nightmare and it shows several flashbacks from the previous Rambo movies of him killing enemy soldiers in Black-and-White. This scene is fairly graphic, but not much.
When a group of mercenaries arrive in Burma, they find the massacred village, with mutilated bodies hung by ropes and much destruction all over the area.
In this scene, a truck drives by and a bunch of soldiers unload with civilian hostages. They force the civilians to run through a swamp with mortars planted in it for gambling purposes. Rambo then intervenes and shoots all four of the soldiers with a bow-and-arrow. He shoots two of them through the torso, one of them through-the-jaw, and the last one directly through the head, causing him to land on a mine and explode. This scene is not too graphic, but body parts are shown flying everywhere after the mine goes off.
Rambo and the mercenaries infiltrate a Burmese Military base attempting to rescue the hostages. During this scene, one of the mercenaries kills a soldier by stabbing a knife in his throat. He then proceeds to stab him in the stomach multiple times. This scene is brief, but is very bloody and graphic.
While rescuing the missionaries, Rambo comes across a bunch of wild Boar feasting on a dead man tied to a pole. We see them eating the stumps of his legs with lots of bloody flesh shown. This scene is brief however, and it is not intense.
"Schoolboy" shoots several soldiers with a .50 caliber sniper rifle. The setting is rather dark so only a moderate amount of blood is visible, but we do briefly see a man's head explode into blood and gore.
A bunch of soldiers struggle with women and tear their clothes off. It is not shown, but it is implied that they are raping the women. The women are shown screaming and trying to escape as the men hold them down. This scene is very intense.
A man is about to rape a woman when Rambo sneaks up behind him and grabs him by the throat. We see blood pouring down from his neck as they struggle, and Rambo literally tears out the man's throat with much blood. The man's broken trachea is actually shown.
While running through the forest, one of the characters steps on a land-mine, which critically injures him. We do briefly see an extremely graphic image of his leg almost completely shredded to the bone. One of the missionaries uses a knife to dig out the shrapnel (this is semi-graphic). The scene is not intense, but it is disturbing.
As the characters attempt to escape from Burma, the soldiers chase after them using attack dogs. So Rambo uses the scent of a piece of clothing to lead the soldiers to a presumably deactivated bomb. He ties it to a claymore, which he plants next to the bomb and runs off. When the soldiers arrive, the bomb is triggered by the claymore, which blows up much of the forest. This scene is not graphic, but it is very intense.
Schoolboy and Sarah watch from the top of a hill as the soldiers brutally beat and torture the mercenaries with a large stick.
Rambo graphically cuts a man's head off with a machette and blood sprays everywhere. He then takes control of a mounted .50 caliber machine gun and shoots the soldier sitting in the front of the jeep. The soldier is completely disintegrated by the bullets and we see his body graphically explode into thousands of gory pieces. Afterwards, and during most of what follows, the shield in front of the gun is shown covered in blood and gore.
This act ultimately begins the film's climactic shootout. Rambo guns down the Burmese soldiers with the machine gun and their bodies pretty much explode into pieces with each hit. A man has his leg blown off at the knee, and several are shown being cut in half at the waist by the high-caliber bullets. A large amount of blood splatter is shown as every soldier is shot.
The mercenaries back Rambo up with assault rifles and explosives. A fair lot of blood splatter is visible when the enemies are shot, and grenades cause them to completely explode into blood and gore.
Lewis kills a man by smashing his face in. En Joo is killed when a grenade goes off next to him, blowing him into the air and shredding much of his chest with shrapnel.
A man is killed by being repeatedly smashed in the head with a rock, lots of blood is visible
Pretty soon, the Karen rebels show up, firing mortars at the soldiers, causing them to disintegrate into gory mist and blood. A boat drives by and sets some of the rebels on fire with a flamethrower, so Rambo guns down the boat with the machine gun and blood splatters everywhere as the drivers are shot.
Schoolboy shoots a gunner on the boat with his sniper rifle, causing the soldier's head to completely explode and gore splatters on the screen. The headless body is shown still standing at the gun for a moment afterwards.
The entire battle scene described above is extremely violent and graphic and goes on for a long time.
Rambo kills the main villain by stabbing him in the stomach with a knife. This part is not graphic, but after looking him in the eyes, he cuts the knife straight out the side of his torso, practically slicing him open. His intestines fall out as Rambo kicks him downhill, and we see that the man is almost completely cut in half as blood splatters all over the place. This scene is extremely graphic and bloody.