- The villains this time are a group of Human Traffickers. They don't care about women and what they are to them. Their leader, Hugo Martinez, outright refer to them as "it", meaning to him, they are things to be sold as merchandise and later thrown out like trash.
- Rambo's interrogation of El Flaco. He stabs him numerous times, once near the neck, and Rambo proceeds to pull out El Flaco's collarbone and snap it in half with his bare hands, just to get him to talk. It's even noted by some viewers that they subconsciously reached for their collarbones at that moment while not even batting an eye at the heart disembowelling at the end of the movie, which shows just how surreal the former was by comparison.
- When Rambo first stumbles upon the traffickers' hideout while searching for Gabriela, some of them slowly begin to stalk him, and upon reaching Hugo and Victor, he finds himself surrounded by them. Rambo attempts to put up a good fight until he is completely overwhelmed and beaten to half death. And when they're done, Victor carves his signature scar on Rambo's cheek as something to remember him by, and Hugo vows to have Rambo live the rest of his life knowing that he will make Gabriela suffer.
- Everything that happens to Gabriela after she's abducted. In mere seconds, her life as an aspiring college student is shattered and gone, forced into a life of slavery, and one she can't hope to possibly ever escape from. While the previous movie held nothing back in depicting the brutality of the Burmese Army, there was no telling if this movie would show everything the traffickers would do to Gabriela. After Rambo fails to rescue her the first time, Victor has a scar carved onto her cheek and she is regularly pumped with drugs against her will, just to spite Rambo. It's not shown outright, but it's all but stated that she was also raped numerous times in captivity. That's why she was kidnapped in the first place, after all, and by the time Rambo gets to her she reacts to him touching her with abject, mindless terror.
- Rambo's attack on the brothel, where he brutally kills the traffickers one by one until he eventually finds and rescues Gabriela. The way he beats them down is a quite painful as he uses a hammer against them. The worst part is, just as he finds Gabriela, she's already dying from a drug overdose inflicted by Victor.
- After Gabriela's death, Rambo decapitates Victor as a message to Hugo. Hugo later enters Victor's house and finds his headless corpse, and it is not a pretty sight. As Rambo drives back home, he later drops his head off on the highway.
- The Final Battle is just as brutal as the finale of the previous movie. When Rambo has the men trapped in the tunnels, the way he takes them out are quite possibly some of the most violent kills in the entire franchise. He stabs one man through the face, blows the men's heads off with shotguns, slices off another man's leg, impales another with a pitchfork, and sends several men falling and impaled on a spike.
- Hugo's death. Remember how at the end of the previous movie Rambo slices out Tint's intestines? In this movie, however, Rambo first pins Hugo to the wall with well-aimed arrow shots, then he disembowels his chest and rips out his still beating heart with his bare hands, like he said he would. This is by far the most brutal and gruesome death in the entire series, already making Tint's death look tame by comparison.
Nightmare Fuel / Rambo: Last Blood